天下之事。统之有宗。会之有元。言简而尽。事核而当。斯为至矣。百家者流。莫大于医。医莫先于脉。浮沉之不
同。迟数之反类。曰阴曰阳。曰表曰里。抑亦以对待而为名象焉。有名象而有统会矣。高阳生之七表八里九道。盖凿凿
也。求脉之明。为脉之晦。或者曰。脉之道大矣。古人之言亦伙矣。犹惧弗及。而欲以此统会该之。不既太简乎。呜呼。
至微者脉之理。而名象着焉。统会寓焉。观其会通。以知其典礼。君子之能事也。由是而推之。则溯流穷源。因此识彼。
诸家之全。亦无遗珠之憾矣。
脉者气血之先也。气血盛则脉盛。气血衰则脉衰。气血热则脉数。气血寒则脉迟。气血微则脉弱。气血平则脉治。
又长人脉长。短人脉短。性急人脉急。性缓人脉缓。左大顺男。右大顺女。男子尺脉常弱。女子尺脉常盛。此皆其常也。
反之者逆。
左手寸口。心小肠脉所出。
左关。肝胆脉所出。
左尺。肾膀胱脉所出。(命门与肾脉通)
右手寸口。肺大肠脉所出。
右关。脾胃脉所出。
右尺命门(心包络手心主)三焦脉所出。
心脉浮大而散。肺脉浮涩而短。肝脉弦而长。脾脉缓而大。肾脉沉而软滑(素问。心平脉。累累如连珠。如循琅 。
此长滑之象也。心为肝子。脉不离弦。故仲景谓心脉洪大而长。肺脉涩短。是动力不盛。而形体铺宽也。)
心合血脉。心脉循血脉而行。持脉指法。如六菽之重。按至血脉而得者为浮。稍稍加力。脉道粗者为大。又稍加力
脉道阔软者为散。
肺合皮毛。肺脉循皮毛而行。持脉指法。如三菽之重。按至皮毛而得者为浮。稍稍加力。脉道不利为涩。又稍加力。
不及本位曰短。(涩只是来势不勇。短只是宽软不挺。)
肝合筋。肝脉循筋而行。持脉指法。如十二菽之重。按至筋而脉道如筝弦相似为弦。次稍加力。脉道迢迢者为长。
脾合肌肉。脾脉循肌肉而行。持脉指法。如九菽之重。按至肌肉如微风轻 柳梢之状为缓。次稍加力。脉道敦实者
为大。
肾合骨。肾脉循骨而行。持脉指法。按至骨上而得者为沉。次重而按之。脉道无力为濡。举指来疾流利者为滑。(濡
是脉体之柔润。非脉应指无力也。)
凡此五脏平脉。要须察之久久成熟。一遇病脉。自然可晓。经曰。先识经脉。而后识病脉。此之谓也。(五脏平脉病
脉死脉。素问玉机真藏平人气象两篇。言之至详且密。此文所叙。乃从难经录出。其义未全。)
天下万事万物,统摄于根本,汇聚于源头。言辞简练而意蕴穷尽,事理确凿且恰当得体,这便达到了极致。在诸子百家中,没有比医学更重要的;而在医学中,没有比脉诊更优先的。浮与沉的不同,迟与数的相反,称为阴或阳,称为表或里,大概也是以相对立的方式来命名和象征的。有了名和象,就有了统摄和汇聚。高阳生提出的“七表、八里、九道”脉法,可以说是确切无疑的。想要使脉理明晰,反而使脉理变得晦涩难懂。有人说:脉道的学问博大精深,古人的论述也非常多,尚且担心不能涵盖周全,却想以此简单的分类来概括它,不是太过简略了吗?唉!脉理是最微妙的,但名和象是显著的,统摄和汇聚寓于其中。观察其会通之处,从而了解其规律,这是君子的能力所在。由此推演,就能追溯源头,通过此认识彼,各家学说的精华也就没有遗漏了。
脉是气血的先导。气血旺盛则脉象旺盛,气血衰弱则脉象衰弱,气血热则脉数(快),气血寒则脉迟(慢),气血微弱则脉弱,气血平和则脉治(正常)。另外,身材高大的人脉长,身材矮小的人脉短,性情急躁的人脉急,性情舒缓的人脉缓。左手脉大符合男性生理特征,右手脉大符合女性生理特征。男子的尺脉通常较弱,女子的尺脉通常较强。这些都是正常的脉象。反之则为逆(异常)。
左手寸口部,是心和小肠脉气发出的部位。
左关部,是肝和胆脉气发出的部位。
左尺部,是肾和膀胱脉气发出的部位。(命门与肾脉相通)
右手寸口部,是肺和大肠脉气发出的部位。
右关部,是脾和胃脉气发出的部位。
右尺部命门(心包络、手心主)和三焦脉气发出的部位。
心的平脉表现为浮大而散。肺的平脉表现为浮涩而短。肝的平脉表现为弦而长。脾的平脉表现为缓而大。肾的平脉表现为沉而软滑。(《素问》记载:心的平脉,累累如连珠,像抚摸美玉一样光滑圆润,这是长滑的脉象。心为肝之子,脉不离弦象,所以张仲景说心脉洪大而长,肺脉涩短,这是因为动力不盛,而形体铺展宽阔。)
心合血脉,心脉沿着血脉运行。切脉指法:如同放置六颗豆子的重量,按至血脉处能摸到脉动的是浮脉。稍稍加重力量,脉道感觉粗大的为大脉。再稍加重力量,脉道感觉宽阔柔软的为散脉。
肺合皮毛,肺脉沿着皮毛运行。切脉指法:如同放置三颗豆子的重量,按至皮毛处能摸到脉动的是浮脉。稍稍加重力量,脉道往来不畅的为涩脉。再稍加重力量,脉动不及本位范围的为短脉。(涩只是来势不勇猛,短只是宽软不挺拔。)
肝合筋,肝脉沿着筋运行。切脉指法:如同放置十二颗豆子的重量,按至筋处脉道像筝弦一样紧绷的为弦脉。次之稍加重力量,脉道悠长为长的脉。
脾合肌肉,脾脉沿着肌肉运行。切脉指法:如同放置九颗豆子的重量,按至肌肉处像微风轻拂柳梢那样柔和的为缓脉。次之稍加重力量,脉道敦实有力的为大脉。
肾合骨,肾脉沿着骨运行。切脉指法:按至骨头上方能摸到脉动的是沉脉。再次重按,脉道无力的为濡脉。轻举手指时脉动疾速流利的是滑脉。(濡是脉体的柔润,并非脉应指无力。)
以上五脏的平脉,必须经过长久的观察和实践才能熟练掌握。一旦遇到病脉,自然能够辨识。经书说:“先识别平脉(常脉),然后才能识别病脉。”说的就是这个道理。(关于五脏的平脉、病脉和死脉,《素问》中的《玉机真藏论》和《平人气象论》两篇讲得非常详细周密。本文所述,是从《难经》中摘录出来的,其义理并不完整。)
All affairs under heaven are unified by a root and gathered by a source. Words are concise yet exhaustive, matters are accurate and appropriate; this is the highest state. Among the various schools of thought, none is greater than medicine. In medicine, none is prior to pulse diagnosis. The differences between floating (Fu) and sinking (Chen), the opposition between slow (Chi) and rapid (Shu), are named Yin or Yang, exterior (Biao) or interior (Li). These are likely named and symbolized through mutual opposition. With names and symbols, there is unity and gathering. Gao Yangsheng's "Seven Tables, Eight Regions, Nine Channels" pulse classification is indeed precise. Seeking clarity in pulses often leads to obscurity. Some say: The way of pulses is vast, and ancient texts on it are numerous; one still fears falling short, yet wishes to summarize it with such a brief classification—is this not too simplistic? Alas! The principle of pulses is subtle, yet names and symbols are manifest, and unity is embedded therein. Observing their convergence allows one to understand their laws; this is the capability of a gentleman. By deducing from this, one can trace the stream to its source and know the other through this. Thus, the completeness of all schools will remain without regret for missed pearls.
Pulses are the precursors of Qi and Blood. When Qi and Blood are abundant, pulses are vigorous; when deficient, pulses are weak. When Qi and Blood are hot, pulses are rapid; when cold, pulses are slow. When Qi and Blood are minute, pulses are weak; when balanced, pulses are normal (Zhi). Furthermore, tall people have long pulses, short people have short pulses, those with impatient temperaments have urgent pulses, and those with calm temperaments have relaxed pulses. A larger left hand pulse suits men, while a larger right hand pulse suits women. Men typically have weaker Chi (Scatter) pulses, while women typically have stronger Chi pulses. These are all normal conditions. Deviations from these are considered adverse (Ni).
The Cun Kou position on the left hand is where the Heart and Small Intestine pulse qi emerges.
The Guan position on the left hand is where the Liver and Gallbladder pulse qi emerges.
The Chi position on the left hand is where the Kidney and Bladder pulse qi emerges. (The Mingmen Gate connects with the Kidney pulse.)
The Cun Kou position on the right hand is where the Lung and Large Intestine pulse qi emerges.
The Guan position on the right hand is where the Spleen and Stomach pulse qi emerges.
The Chi position on the right hand, associated with Mingmen Gate (Pericardium/Heart Protector, Hand Shaoyin), is where the Sanjiao (Triple Burner) pulse qi emerges.
The normal pulse of the Heart is floating, large, and scattered. The normal pulse of the Lung is floating, choppy, and short. The normal pulse of the Liver is wiry (Xian) and long. The normal pulse of the Spleen is moderate (Huan) and large. The normal pulse of the Kidney is deep (Chen), soft, and slippery (Hua). (*Suwen* states: The normal pulse of the Heart resembles linked pearls, smooth like touching jade, which is an image of long and slippery pulses. Since the Heart is the child of the Liver, the pulse does not depart from the wiry quality; thus Zhang Zhongjing described the Heart pulse as洪大 (Hongda - surging and large) and long, and the Lung pulse as choppy and short, indicating that while dynamic force may not be vigorous, the physical form spreads widely.)
The Heart governs the blood vessels, and the Heart pulse travels along the blood vessels. For palpation technique: Apply pressure equivalent to the weight of six beans. If the pulse is felt at the level of the blood vessels, it is a Floating (Fu) pulse. Slightly increase pressure; if the pulse channel feels coarse, it is a Large (Da) pulse. Increase pressure slightly more; if the pulse channel feels broad and soft, it is a Scattered (San) pulse.
The Lung governs the skin and hair, and the Lung pulse travels along the skin and hair. For palpation technique: Apply pressure equivalent to the weight of three beans. If the pulse is felt at the level of the skin, it is a Floating (Fu) pulse. Slightly increase pressure; if the pulse flow is obstructed, it is a Choppy (Se) pulse. Increase pressure slightly more; if the pulse does not reach its full extent, it is a Short (Duan) pulse. (Choppy refers only to a lack of vigorous incoming momentum; Short refers only to being broad, soft, and lacking firmness.)
The Liver governs the sinews, and the Liver pulse travels along the sinews. For palpation technique: Apply pressure equivalent to the weight of twelve beans. If the pulse channel feels taut like a zither string, it is a Wiry (Xian) pulse. Slightly increase pressure; if the pulse channel stretches far, it is a Long (Chang) pulse.
The Spleen governs the muscles, and the Spleen pulse travels along the muscles. For palpation technique: Apply pressure equivalent to the weight of nine beans. If the pulse feels like a gentle breeze brushing willow tips, it is a Moderate (Huan) pulse. Slightly increase pressure; if the pulse channel feels solid and substantial, it is a Large (Da) pulse.
The Kidney governs the bones, and the Kidney pulse travels along the bones. For palpation technique: Press until the bone level to feel the pulse; this is a Deep (Chen) pulse. Press heavier; if the pulse channel lacks strength, it is a Soft (Ru) pulse. Lifting the finger reveals a rapid and fluent pulse; this is a Slippery (Hua) pulse. (Soft refers to the pliability of the pulse body, not necessarily a lack of response to pressure.)
To master the normal pulses of the five Zang organs requires long-term observation and practice. Once mastered, pathological pulses will naturally become clear. The classics state: "First recognize the normal pulse, then recognize the pathological pulse." This is what is meant. (Regarding the normal, pathological, and death pulses of the five Zang organs, *Suwen*'s *Yuji Zhenzang Lun* and *Pingren Qixiang Lun* discuss them in great detail. The narrative here is excerpted from *Nanjing*, and its theoretical completeness is not fully presented.)