缓脉,本有二义。一为和缓之缓,则一息四至,胃气之正,所谓不大不小,不刚不柔,
意思欣欣,难以名状者。无病之脉,当如是也。一为怠缓之缓,则濡滞不前,湿阻中州者有
之,而湿流关节者亦有之。故疡病而得和缓之脉,即合中和之气,无论已溃未溃,无非泰境
。而得怠缓之脉者,亦无往而非湿邪之留着也。
芤者,脉之中空者也,是为失血之候。盖血液既泄,脉道不充,有如葱管,凡失血家往
往见之,固非昔贤之空言也。
而疡病在未溃之时,于法当无芤象;如果有之,则其人平时之亡血者也。若在溃后,则
脓血大泄,时亦偶一遇之。然苟非大证日久,脓去甚多者,亦不恒有此脉。补养滋填,势不
可缓。
动者,脉之一粒突起,如珠如豆,厥厥动摇者也。于法主痛。盖痛则气滞,着而不行,
脉道不能条达,因而凝聚一处,如珠动摇。此虽不恒有之脉象,虽阅历多者,固时一见之。
(《素问》谓妇人手少阴脉动甚者,妊子也。是亦气血初凝,脉行不畅之理。诊妊脉者,亦
或
为此。否则痛盛气结,而脉应之。是皆当从事于宣通疏泄,而求其气机之条畅者也。
伏者,脉之沉伏不见者也。轻按不得,必极重按之,而始一应指。苟非病邪之深邃,则
阴寒之凝固也。否则大痛气结,而脉为之阻也。故以外疡言之,病在肌肉,于脉必不当伏。
如果有之,则附骨大疽,盘根错节,必非一朝一夕之故矣。而大毒酿脓,病势极炽之时,亦
偶一见之,则痛极不通,脉涩已甚,即沉伏不见。如在溃后,则其毒已泄,其气已通,更不
当再有伏藏之脉。尚亦见之,则其毒固结,不以脓成而稍减其势,其凶何如。
缓脉,原本包含两层含义。一是“和缓”之缓,指一呼一吸之间脉搏跳动四次,这是胃气正常的表现,所谓不大不小、不刚不柔,神态欣欣向荣,难以用语言确切形容的脉象。没有疾病的人,脉象应当如此。二是“怠缓”之缓,指脉来濡滞不前,这种情况有的是因为湿气阻滞在中焦(脾胃),也有的是因为湿气流注于关节。因此,外科疾病如果出现和缓之脉,就符合中和之气,无论疮疡已经溃破还是未溃破,都是顺境(吉兆)。而如果出现怠缓之脉,则无不表示湿邪留滞体内。
芤脉,是指脉象中间空虚,这是失血的征候。因为血液流失后,脉道充盈不足,就像葱管一样中空,凡是失血的患者往往会出现这种脉象,这确实不是古代贤人空泛的言论。
而在外科疾病在未溃破的时候,按常理应当不会出现芤脉;如果出现,说明该患者平时就有慢性失血的情况。如果在溃破之后,脓血大量流失,有时也会偶尔见到芤脉。但是,如果不是病程长久的大证,且脓液排出极多的情况,也不会经常见到这种脉象。此时必须立即进行补养滋填的治疗,刻不容缓。
动脉,是指脉搏中有一粒突起,像珠子或豆子一样,厥厥然跳动的脉象。按常理主痛证。因为疼痛会导致气机阻滞,附着而不运行,脉道不能条达通畅,因而凝聚在一处,像珠子一样动摇。这种脉象虽然不常出现,但即使阅历丰富的医生,也时常能见到。(《素问》说妇女手少阴脉动甚,是怀孕的征兆。这也是气血初凝,脉行不畅的道理。诊察妊娠脉时,也可能为此原因。否则就是疼痛剧烈导致气结,脉象随之反应。这些情况都应当采用宣通疏泄的方法,以求气机条达顺畅。)
伏脉,是指脉象深沉潜伏,表面看不见摸不着。轻取不得,必须极重按才能应指感觉到。如果不是病邪深入,就是阴寒凝固所致。否则就是剧烈疼痛导致气机郁结,脉道被阻遏。所以从外科疮疡来说,病位在肌肉层面,脉象必然不应该呈现伏脉。如果出现伏脉,那一定是附骨疽这样的大毒,根深蒂固,盘根错节,绝非一朝一夕形成的。在大毒酝酿成脓,病势极其炽盛的时候,也偶尔能见到伏脉,这是因为痛极不通,脉涩非常严重,所以沉伏不见。如果在溃破之后,毒邪已经排泄,气机已经通畅,更不应该再有伏藏之脉。如果此时还见到伏脉,说明毒邪固结,并没有因为脓成而稍微减弱其势头,其凶险程度如何可想而知。
Huan pulse (Slow/Relaxed Pulse) originally has two meanings. One is "harmonious and relaxed" (Hehuan), where the pulse beats four times per respiratory cycle, representing normal Stomach Qi (Wei Qi). It is described as neither too large nor too small, neither too rigid nor too soft, with a vibrant spirit that is difficult to describe in words. The pulse of a healthy person should be like this. The other is "lethargic and sluggish" (Daihuan), where the pulse feels damp and stagnant, failing to advance smoothly. This may be due to Dampness obstructing the Middle Jiao (Spleen and Stomach region), or Dampness flowing into the joints. Therefore, if a surgical disease presents with a harmonious and relaxed pulse, it aligns with the Qi of Harmony and Balance; regardless of whether the abscess has ulcerated or not, it indicates a favorable condition. Conversely, if a lethargic and sluggish pulse is present, it invariably indicates the lingering presence of Dampness pathogen.
Kou pulse (Hollow Pulse) refers to a pulse that is empty in the middle, which is a sign of blood loss. Since blood volume has decreased, the pulse channel is not fully filled, resembling a scallion stalk. Patients who have suffered blood loss often exhibit this pulse, confirming that this is not merely an empty statement by ancient sages.
In surgical diseases before ulceration, according to principles, a Kou pulse should not appear; if it does, it indicates that the patient has been suffering from chronic blood loss. After ulceration, when pus and blood are discharged in large quantities, a Kou pulse may occasionally be observed. However, unless it is a severe condition lasting for a long time with massive discharge of pus, this pulse is not commonly seen. In such cases, nourishing and tonifying treatments cannot be delayed.
Dong pulse (Moving Pulse) refers to a pulse where a single bead-like prominence rises, moving like a pearl or bean, quivering and shaking. According to principles, it primarily indicates pain. Pain causes Qi stagnation, which adheres and fails to circulate, preventing the pulse channel from flowing freely, causing it to condense in one area, moving like a pearl. Although this pulse image is not constant, even experienced physicians encounter it from time to time. (The *Suwen* states that if the Hand-Shaoyin pulse moves vigorously in women, it indicates pregnancy. This is also due to the initial coagulation of Qi and Blood and unsmooth pulse flow. When diagnosing pregnancy pulses, this may also be the cause. Otherwise, severe pain leads to Qi knotting, and the pulse responds accordingly. In all these cases, methods of diffusing and draining should be employed to seek smooth and free Qi mechanism.)
Fu pulse (Hidden Pulse) refers to a pulse that is deeply hidden and invisible. It cannot be felt with light pressure but only becomes palpable with extreme heavy pressure. Unless it is due to deep-seated pathogens or congealing Yin-Cold, it is otherwise caused by severe pain leading to Qi stagnation and obstruction of the pulse channel. Thus, regarding external sores, if the disease is located in the muscles, the pulse should certainly not be Fu. If a Fu pulse appears, it must be a deep-rooted abscess like Agujuzhong (Bone-attached Abscess), with complex roots, formed over a long period, not overnight. During the peak of toxicity when pus is forming and the disease momentum is extremely fierce, a Fu pulse may occasionally be seen, indicating that extreme pain blocks flow, making the pulse very choppy and thus hidden. After ulceration, since the toxin has been discharged and Qi is unblocked, a hidden pulse should no longer appear. If it is still seen, it means the toxin remains firmly consolidated and has not diminished despite pus formation; how dire the situation would be can be imagined.