窃闻人有是病,即有是脉,此大概言之。其得心应手全在审视,未必专尚乎诊也。如病目必视其症为外为内,
必审其何因而致,所伤之风邪在何脏腑,得其情而后切以印可,治无不当。但诊惟外之手,即欲理会方药,不以
人性命为儿戏耶?语曰∶学医人费解皆脉之使之也。间亦有切而知者,仅谓之巧中。然施于本经,十失八九。盖
医门之事,目与五行最为亲切,药之优劣当面定夺,万难藏拙,非比别病之无对症,而可以横口不根,夸张脉理。
试匿青盲妇,令当家诊之,其上、下、来、去、至、止,曷常于平人迥异?诳以赤肿必作风热处
方。讵知目不能治,而身之元无恙耶?是故舍可见可闻之耳目,而凭一无形无影之手指,其症候必猜度拟议之,
而用药亦猜度拟议之药尔。庸医误人,孰有甚于此者!李时珍曰∶医病两家咸以脉为首务,不知脉乃四诊之末,
上士欲会其全,非备四诊不可。孙思邈亦曰∶未诊先问,最为有准。是则百病之不可恃乎脉也明矣,况目乎?不
宁维是,夫人百骸九窍,皆丝脉联系以通血气,自项至踵,周流不息。凡骨节之间皆有之,但手腕较着,以便诊
耳,未必十二经络左右平分,分则尽总于此,一寸二寸,如发如缕,似气非筋之脉。即使尽总于此,病患之臂有
长短,医人之指有大小,倘前后失序,不几以神门为尺,以人迎气为关耶?病患之脉有常变,医人之气有疾徐,
倘呼吸不匀,不几以三至为急,以五至六至为缓耶?前人不计及比,漫演为奇经,为太素,为广经、孙输络,为
状尖、圆、长、短、扁,为辨高、章、纲、 、卑、损,愈阐愈凿,愈凿愈元,而脉之本源尽失。孟子曰∶道在
迩而求诸远,事在易而求诸难,此之谓也。呜呼!之数人者,妄出一己之私见,以欺天下后世之耳目。而索隐行
怪之徒,神其说以射利,至今习俗成风,虽儒医亦用而术。屡欲条陈荒谬,以靖流弊,恐世人以假遇假,实论相
参,则是非争起。且谓医家之诊切,犹兵家之旗鼓。夫旗鼓何助于战,乃所以扬威陷阵者,端赖此耳。又子从事
渔猎,而废网罗之具,是自败其道也,姑仍旧本而已。至若《太素》一书,务必屏绝。盖医家以岐黄为祖,所论
脉不过察病情、决生死,未有所谓《太素》也。神明如仓公、扁鹊、仲景、叔和,亦无所谓《太素》也。彼何人
斯?不惟测人之病情,而能占人之穷通,不惟决人之死生,而能知人之祸福,异端之说,攻之斯害,岂特载鬼一
车,徒令人狐惑已也。爰立斯
论,并商订脉体诊诀于后,读者不病其简,不责以狂,虚心周虑而转应之,自然不尚乎脉,自然巧合于脉。大概
言有是病,大概即有是脉。
我听说人有某种病,就会有某种脉象,这是从大体上说的。但医生要做到得心应手,全在于仔细审视(观察),未必非要专门依赖诊脉。比如治疗眼病,必须观察症状是属于外感还是内伤,必须审察是由什么原因引起的,所伤的风邪位于哪个脏腑,了解了这些情况之后,再切脉来印证,治疗就没有不恰当的。如果只诊察手腕处的脉搏,就想处理方药,不把病人的性命当儿戏吗?俗话说:学医的人觉得难以理解,都是被脉理所误导的。间或也有通过切脉而知晓病情的,这只能称为“巧中”(偶然猜中)。然而将其应用于眼科,十次会失误八九次。因为医学领域中,眼睛与五行理论最为密切,药物的优劣应当当面定夺,很难隐藏拙劣之处,不像其他疾病没有对症依据,就可以信口开河、夸大脉理。试着让盲人妇女(青盲患者)假装存在,让家属来诊脉,其脉象的上、下、来、去、至、止,哪里常常与健康人截然不同呢?若谎称眼睛红肿是风热所致而开具处方,岂知眼病治不好,而身体原本并无大碍呢?因此,舍弃可见可闻的耳目观察,而凭借无形无影的手指切脉,对症状候必是猜测揣度,用药也是猜测揣度的药物罢了。庸医误人,还有比这更严重的吗!李时珍说:医生和病人双方都把脉诊作为首要任务,却不知道脉诊只是四诊之一,高明的人想要全面掌握医术,必须具备四诊(望、闻、问、切)。孙思邈也说:未诊先问,最为准确。那么百病不可单靠脉诊是显而易见的,何况是眼病呢?不仅如此,人的全身骨骼九窍,都由经络联系以通行气血,从颈部到脚后跟,周流不息。凡骨节之间都有经络,只是手腕处较为明显,便于诊察而已,未必十二经络左右平分,如果平分,则全部汇聚于此,一寸二寸粗细,如发如缕,似气非筋的脉。即使全部汇聚于此,病人的手臂有长短,医生的手指有大小,倘若前后次序失当,岂不是把神门穴当作尺部,把人迎穴当作关部吗?病人的脉象有常变,医生的气息有疾徐,倘若呼吸不均匀,岂不是把三至当作急脉,把五至六至当作缓脉吗?前人没有考虑到这些,随意演绎出奇经、太素、广经、孙输络等概念,以及状尖、圆、长、短、扁等形态,以及辨高、章、纲、卑、损等分类,越阐发越穿凿,越穿凿越荒谬,而脉的本源完全丧失。孟子说:道在近处却向远处寻求,事在容易处却向难处寻求,说的就是这种情况。唉!这几个人,妄加发表一己之私见,用来欺骗天下后世的耳目。而那些追求隐僻怪异之说的人,神化这种说法以谋取利益,至今习俗已成风气,即使是儒医也使用并推崇它。多次想条陈这些荒谬之处,以平息流弊,恐怕世人会以假乱真,实论相参,从而是非之争兴起。况且认为医家的诊切,就像兵家的旗鼓。旗鼓对战局有何帮助,那是用来扬威陷阵的,确实依赖这个。又如同从事渔猎,却废弃了网罗的工具,这是自败其道,姑且沿袭旧本罢了。至于《太素》一书,务必摒弃排斥。因为医家以岐伯、黄帝为祖师,所论述的脉不过是为了察病情、决生死,并没有所谓的《太素》。神明如仓公、扁鹊、张仲景、王叔和,也没有所谓《太素》。那些人是什么人呢?不仅推测人的病情,还能占卜人的穷通命运;不仅决定人的死生,还能知道人的祸福,这是异端之说,攻击它尚且有害,难道只是记载了一车鬼怪,徒然让人狐惑不安罢了。于是设立这篇论述,并在后面商订脉体诊诀,读者不要嫌其简略,不要指责其狂妄,虚心周全考虑而转应之,自然不崇尚脉诊,自然也能契合脉理。大体上说,有什么病,大概也就有什么脉。
I have heard that when a person has a certain disease, there is a corresponding pulse; this is a general statement. However, for a physician to achieve proficiency and ease in treatment, it relies entirely on careful observation (inspection), and does not necessarily depend solely on pulse diagnosis. For instance, when treating eye diseases, one must observe whether the symptoms are external or internal, determine the etiology, identify which Zang-Fu organs are affected by the pathogenic wind-evil, and only after understanding these conditions should pulse palpation be used to verify them, ensuring appropriate treatment. If one merely palpates the pulse at the wrist yet attempts to prescribe herbal formulas, is this not treating human life as a trivial matter? It is said: "Those who study medicine find it difficult to comprehend, largely due to being misled by pulse theory." Occasionally, some may diagnose correctly through pulse palpation alone, but this can only be called "coincidental accuracy" (accidental hit). However, applying this method to ophthalmology results in eight or nine errors out of ten. This is because, within the medical field, the eyes are most intimately connected with the Five Elements theory. The quality of herbs must be determined face-to-face, making it difficult to hide incompetence, unlike other diseases where one might speak without basis and exaggerate pulse theories. Suppose we pretend there is a patient with Qingmang (blindness), and ask their family member to take their pulse. Would the pulse's upward/downward, coming/going, arriving/stopping characteristics truly differ significantly from those of a healthy person? If one falsely claims that redness and swelling are caused by Wind-Heat and prescribes accordingly, who would know that while the eye condition remains untreated, the body's vital essence remains unharmed? Therefore, abandoning the visible and audible senses (Inspection and Auscultation/Olfaction) to rely on invisible fingers for pulse taking means that symptom assessment becomes speculative, and medication choices become speculative as well. Are there any greater errors committed by mediocre physicians than this? Li Shizhen stated: "Both doctors and patients prioritize pulse diagnosis, unaware that pulse taking is merely the last of the Four Diagnostic Methods. A superior physician seeking comprehensive knowledge must employ all four methods." Sun Simiao also said: "Inquiring before diagnosing is the most accurate approach." Thus, it is clear that hundred diseases cannot rely solely on pulse diagnosis, let alone eye diseases. Furthermore, the human body's bones and orifices are interconnected by meridians to circulate Qi and Blood, flowing continuously from the neck to the heels. Meridians exist at every joint, but they are most prominent at the wrist for diagnostic convenience. They are not necessarily divided equally between left and right; if they were, all twelve meridians would converge here. These pulses, measuring one or two cun, thin as hair or thread, resembling Qi rather than tendons—even if they all converged here—patients' arms vary in length, and physicians' fingers vary in size. If the sequence is disordered, would one not mistake Shenmen (HT7) for the Chi position, and Renying (ST9) for the Guan position? Patients' pulses vary, and physicians' breathing rates differ. If respiration is uneven, would one not mistake three beats per breath for a rapid pulse, and five or six beats for a slow pulse? Predecessors failed to consider these factors, arbitrarily elaborating concepts such as Extraordinary Vessels, Taisu (Supreme Purity), Guangjing, Sunshuluo, and shapes like sharp, round, long, short, flat, and classifications like high, zhang, gang, bei, sun. The more they elaborated, the more far-fetched it became, until the original source of pulse theory was completely lost. Mencius said: "The Way is near, yet sought from afar; matters are easy, yet sought as difficult." This describes the situation. Alas! These individuals, acting on personal prejudices, deceive the world and future generations. Those who pursue obscure and bizarre theories spiritualize these claims to profit, and this custom has become prevalent, even adopted by Confucian physicians. I have repeatedly wished to expose these absurdities to stop the malpractice, fearing that people might confuse falsehood with truth, leading to disputes over right and wrong. Moreover, comparing a physician's pulse diagnosis to a military commander's flags and drums is flawed. Flags and drums do not help in battle; they are used to display majesty and charge into enemy lines. Relying solely on them is like engaging in fishing while discarding nets; it is self-defeating. One should stick to the fundamental principles. As for the book *Taisu*, it must be rejected. Physicians revere Huangdi and Qibo as ancestors; their discussions on pulse aim only to assess disease conditions and determine life and death, with no mention of *Taisu*. Even divine figures like Cang Gong, Bian Que, Zhang Zhongjing, and Wang Shuhe had no concept of *Taisu*. Who were these people? Not only did they speculate on disease conditions but also predict fortune and misfortune, determining life and death while knowing blessings and curses. Such heterodox teachings are harmful even to critique; they are akin to recording a cart full of ghosts, merely causing confusion and anxiety. Therefore, I establish this treatise and discuss pulse morphology and diagnostic rules below. Readers should not complain of its brevity nor accuse me of arrogance. By thinking carefully and responding flexibly, one will naturally not overly rely on pulse diagnosis, yet naturally align with pulse principles. Generally speaking, where there is a disease, there is generally a corresponding pulse.