《素问·平人气象论》曰∶妇人手少阴脉动甚者,妊子也。
手少阴,心脉也。心主血,肾藏精,精血盛而凝结成孕。月事不下,心火上炎,而脉动甚,故亦有烦渴欲
呕等证,因火炎,浊气不得下通故也。然其脉象和滑而非病,其肾脉亦必流利而充实,即知其有妊也。若心脉
虚动,肾脉不滑而涩,其月事不来,此乃血瘀,心火虚动而非孕,久必成病也。此云妊子者,兼男女而言,若
欲辨别,其脉左旺寸旺,为阳为男,右旺尺
旺,为阴为女。又本经《腹中论》曰∶何以知怀子之且生也?岐伯曰∶身有病而无邪脉也。无邪脉者,谓无涩
滞不和,而脉流利柔滑也;有病者,谓月事不通,及烦渴思食酸物欲呕等,将生则腹痛也。
《素问·阴阳别论》曰∶阴搏阳别,谓之有子。阴阳虚,肠 ,死。阳加于阴,谓之汗;阴虚阳搏,谓
之崩。三阴俱搏,二十日夜半死;二阴俱搏,十三日夕时死;一阴俱搏,十日死;三阳俱搏,且鼓,三日死;
三阴三阳俱搏,心腹满发尽,不得隐曲,五日死;二阳俱搏,其病温,死不治,不过十日死。
此论脉象,必以和缓胃气为本,若搏击而不柔缓,皆为病脉,独妇人怀孕不同,故首标明。阴搏阳别者,
如尺部,如沉候,皆为阴,而搏击有力,与阳部浮候之脉别异,此精血充盛,必搏击流利,而不涩滞,乃为有
子之象也。如涩滞,即为血瘀,若瘀结久,必有腹痛胀满等病也。若脉阴阳俱虚,而又肠 ,下泄不止,此无
论男女,皆本元虚脱不能收摄,故死也。阳加于阴者,阳邪乘阴,津液发泄而为汗,如恶风者,当用仲景桂枝
汤;如不恶风而寐即出者,名盗汗,审无外邪,当滋阴为主也。阴脉虚,阳脉搏,是阳亢不能统血归经,遂致
暴崩,此专指妇人也。若三阴俱搏,是无胃气之真脏脉,延二十日,交过一气,又加一候,至夜半阴极而阳气
不生,则死矣。二阴搏、一阴搏,皆大同小异也。三阳俱搏且鼓,三阴三阳俱搏,皆真脏脉,又兼心腹满,正
败而邪盛,言发尽者,胀满极也,不得隐曲者,二便不通也,此即关格证,故皆死也。二阳俱搏,其病温者,
孤阳无阴,不过二候而死。
《素问·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?岐伯曰∶喘鸣肩息者,脉实大也,缓则生,急则死。
乳子者,新产乳哺其子之妇人也。新产脱血,而患温热病,其脉小者,正虚邪盛也,若手足温,其脾胃阳
和之气尚能周布而生;手足寒,则阳气厥逆而死也。若中风热阳邪,而受于上部阳分,心肺气逆,故喘鸣肩息,
乃喘息有声而抬肩也,邪壅于上,故脉必实大,若和缓有胃气者,但泻其邪热,可生;若实大急强,是气脱之
真脏脉,则死矣。
《素问·平人气象论》中说:妇女的手少阴脉(位于左寸,反映心气)搏动明显有力的,是怀孕的征象。
手少阴脉对应的是心脉。心主司血液,肾贮藏精气,精与血充盛并凝结便形成妊娠。月经停止不来,心火向上炎蒸,导致脉搏跳动特别剧烈,因此也会出现心烦、口渴、想要呕吐等症状,这是因为火热之邪上炎,使得浊气不能向下通畅运行所致。然而这种脉象是和缓滑利的,并非病脉;其肾脉也必然流利而充实,据此就可以知道是怀孕了。如果心脉虚浮而动,肾脉不滑利反而涩滞,月经不来,这是血瘀阻滞,属于心火虚性躁动而非怀孕,时间久了必定会生病。这里所说的“妊子”,是兼指怀男胎或女胎而言;如果想要辨别性别,左手脉旺且寸部脉旺的,属阳,为男胎;右手脉旺且尺部脉旺的,属阴,为女胎。
另外,《黄帝内经·腹中论》中说:怎么知道孕妇快要分娩了呢?岐伯回答说:身体虽然有病症表现,但脉象没有邪气干扰。所谓“无邪脉”,是指脉象没有涩滞和不和顺,而是流利柔滑;所谓“有病”,是指月经不通畅,以及心烦、口渴、想吃酸味食物、想要呕吐等症状,即将分娩时会出现腹痛。
《素问·阴阳别论》中说:阴部脉搏动有力,与阳部脉象有别,这叫做怀孕。如果阴阳两虚,出现肠鸣泄泻,就会死亡。阳气加于阴分,称为出汗;阴虚而阳脉搏动强劲,称为崩漏(妇女非经期大量出血)。三条阴经的脉象都搏击有力,二十天后的半夜会死亡;两条阴经的脉象都搏击有力,十三天的傍晚会死亡;一条阴经的脉象都搏击有力,十天会死亡;三条阳经的脉象都搏击有力且鼓动,三天会死亡;三条阴经和三条阳经的脉象都搏击有力,心腹胀满症状全部发作,大小便不通畅,五天会死亡;两条阳经的脉象都搏击有力,患温病,无法治疗,不超过十天就会死亡。
这段论述脉象,必须以和缓有胃气为根本,如果脉象搏击有力而不柔和缓慢,都是病脉,唯独妇人怀孕的情况不同,所以首先明确标出。“阴搏阳别”的意思,比如尺部脉、沉取候脉都属于阴,如果搏动有力,与阳部浮取候脉的脉象不同,这是精血充盛的表现,脉象必然搏击流利,而不涩滞,这才是怀孕的征象。如果出现涩滞,就是血瘀,如果瘀结时间久,必然会有腹痛、胀满等疾病。如果脉象阴阳两部都虚弱,又出现肠鸣泄泻,下泄不止,这无论男女,都是本元虚脱不能固摄,所以会死亡。所谓“阳加于阴”,是阳邪侵袭阴分,津液外泄而成为汗出;如果有恶风症状,应当使用张仲景的桂枝汤;如果不恶风且在睡眠中出汗,名叫盗汗,审查确认没有外邪,应当以滋阴为主。阴脉虚弱,阳脉搏动强劲,这是阳亢盛不能统摄血液回归经脉,从而导致暴崩,这专门指妇女而言。如果三条阴经的脉象都搏击有力,这是没有胃气的真脏脉,拖延二十天,经过一个节气,再加一候,到了夜半阴极而阳气不生,就会死亡。二阴搏、一阴搏,情况大体相同略有差异。三阳俱搏且鼓动,三阴三阳俱搏,都是真脏脉,又兼有心腹胀满,正气败坏而邪气盛极,“发尽”是指胀满到了极点,“不得隐曲”是指大小便不通畅,这就是关格证,所以都会死亡。二阳俱搏,患温病的,孤阳无阴,不超过两个时辰(注:原文语境可能指较短时间或特定周期,此处依文意译为不过十日死的前半段逻辑,结合后文“不过十日死”,此处保留原文逻辑)就会死亡。
《素问·通评虚实论》中黄帝问:哺乳期的妇女患了热病,脉象悬小,怎么样?岐伯回答说:手足温暖就能生,手足寒冷就会死亡。黄帝问:哺乳期妇女感受风热邪气,出现喘息有声、抬肩呼吸的症状,脉象怎么样?岐伯回答说:出现喘息有声、抬肩呼吸症状的,脉象应该是实大的,脉势缓和就能生,脉势急疾就会死亡。
所谓“乳子”,是指新近生产并正在哺乳婴儿的妇女。新产后失血,又患上温热病,如果脉象小,这是正气虚弱而邪气盛实;如果手足温暖,说明脾胃阳气尚能周流布散,就能生存;如果手足寒冷,则是阳气厥逆,就会死亡。如果感受风热阳邪,邪气侵犯上部阳分,导致心肺之气上逆,所以出现喘息有声、抬肩呼吸的现象,这是喘息有声且耸肩,邪气壅塞在上部,所以脉象必然实大;如果脉象和缓且有胃气,只要泻去邪热,就能生存;如果脉象实大且急强,这是气脱的真脏脉,就会死亡。
The *Suwen · Pingren Qixiang Lun* states: When the Shou Shaoyin pulse (located at the left Cun position, reflecting Heart Qi) of a woman beats strongly and noticeably, it indicates pregnancy.
The Shou Shaoyin pulse corresponds to the Heart pulse. The Heart governs Blood, and the Kidney stores Essence. When Essence and Blood are abundant and condense, pregnancy is formed. Menstruation ceases, Heart Fire flares upward, causing the pulse to beat particularly vigorously; therefore, symptoms such as irritability, thirst, and nausea may also appear. This is because the flaming fire prevents turbid Qi from flowing downward smoothly. However, this pulse image is harmonious and slippery, not a pathological pulse; the Kidney pulse must also be fluent and substantial. Based on this, one can know that she is pregnant. If the Heart pulse is deficient and floating with movement, and the Kidney pulse is not slippery but rather choppy, and menstruation has ceased, this is Blood stasis. It is a deficiency-type restless Heart Fire, not pregnancy, and if prolonged, it will inevitably become a disease. The term "pregnant with a child" mentioned here covers both male and female fetuses. To distinguish the gender: if the Left hand pulse is vigorous and the Cun position is vigorous, it is Yang and indicates a male fetus; if the Right hand pulse is vigorous and the Chi position is vigorous, it is Yin and indicates a female fetus.
Furthermore, the *Fuzhong Lun* chapter of this classic states: How do we know that a pregnant woman is about to give birth? Qibo answered: The body has symptoms, but the pulse lacks pathogenic signs. "Lacking pathogenic signs" means the pulse is not choppy or discordant, but fluent and soft-slippery; "having symptoms" refers to the obstruction of menstruation, as well as irritability, thirst, craving for sour foods, and nausea. Abdominal pain occurs just before delivery.
The *Yinyang Bie Lun* chapter states: Yin pulses beating strongly, distinct from Yang pulses, is called having a child. If both Yin and Yang are deficient, accompanied by intestinal rumbling and diarrhea, death ensues. Yang adding to Yin is called sweating; Yin deficiency with Yang pulsation is called Bing (metrorrhagia). If all three Yin meridians' pulses beat strongly, death occurs at midnight after twenty days; if two Yin meridians' pulses beat strongly, death occurs in the evening after thirteen days; if one Yin meridian's pulse beats strongly, death occurs after ten days; if all three Yang meridians' pulses beat strongly and drum-like, death occurs after three days; if all three Yin and three Yang meridians' pulses beat strongly, with fullness of the heart and abdomen manifesting completely, and inability to perform private functions (urination/defecation), death occurs after five days; if two Yang meridians' pulses beat strongly, the disease is Warmth, untreatable, and death occurs within ten days.
This discussion on pulse images emphasizes that harmony and slow rhythm (Stomach Qi) are fundamental. If the pulse beats strongly without being soft and slow, it is a pathological pulse. Only in the case of pregnancy in women is this different, which is why it is explicitly marked first. "Yin beating strongly, distinct from Yang" refers to positions like Chi or deep palpation, which belong to Yin. If they beat strongly, differing from the superficial palpation of Yang positions, this indicates abundant Essence and Blood. The pulse must beat fluently without choppiness, which is the sign of pregnancy. If choppy, it is Blood stasis; long-standing stasis will inevitably cause abdominal pain and distension. If both Yin and Yang pulses are deficient, accompanied by intestinal rumbling and incessant diarrhea, regardless of gender, this is collapse of the root Yuan Qi unable to secure and retain, leading to death. "Yang adding to Yin" means Yang pathogen invading Yin, causing fluids to dissipate as sweat. If there is aversion to wind, Zhang Zhongjing's Guizhi Tang should be used; if there is no aversion to wind but sweating occurs during sleep, it is called Night Sweats. Examining that there are no external pathogens, treatment should focus on nourishing Yin. Deficient Yin pulse and strong Yang pulsation indicate Yang hyperactivity failing to control Blood returning to the vessels, resulting in sudden Bing, specifically referring to women. If all three Yin meridians' pulses beat strongly, this is the Zang-Fu true organ pulse lacking Stomach Qi. After twenty days, passing through a Jieqi (solar term) and adding a Hou (five-day period), reaching midnight where Yin is extreme and Yang Qi cannot generate, death occurs. Two Yin and One Yin pulsations are largely similar with minor differences. Three Yang pulsating and drumming, and three Yin and three Yang pulsating together, are all true organ pulses, combined with heart and abdominal fullness. "Fa jin" means extreme distension; "bud e yinqu" means obstruction of urination and defecation. This is the Guan Ge syndrome, hence death ensues. Two Yang pulsating with Warmth disease implies solitary Yang without Yin, leading to death within two Hou periods.
In the *Tongping Xushi Lun* chapter, the Yellow Emperor asked: A nursing mother suffers from heat disease; what if the pulse is suspended and small? Qibo answered: Survival if hands and feet are warm; death if cold. The Yellow Emperor asked: A nursing mother contracts Wind-Heat; she wheezes with audible sounds and breathes using shoulder muscles. What is the pulse like? Qibo answered: For wheezing with audible sounds and shoulder breathing, the pulse should be Excess and Large. Survival if slow/relaxed; death if rapid/tight.
"Nursing mother" refers to a woman who has recently given birth and is breastfeeding. Postpartum blood loss combined with Warm-Heat disease results in a small pulse, indicating deficient Zheng Qi and excess Xie Qi. If hands and feet are warm, the Spleen-Stomach Yang Qi is still able to circulate and sustain life; if cold, Yang Qi has reversed, leading to death. If contracting Wind-Heat Yang pathogen affecting the upper Yang regions, causing rebellious Qi in the Heart and Lungs, wheezing with audible sounds and shoulder breathing occurs. This is wheezing with sound and raising shoulders, with pathogen obstructing the upper jiao, so the pulse must be Excess and Large. If harmonious with Stomach Qi, clearing the pathogenic heat leads to survival; if Excess, Large, Rapid, and Strong, it is the True Organ pulse of Qi collapse, leading to death.