体象 数脉属阳,象为太过;一息六至,往来越度。
主病 数脉主腑,其病为热。寸数喘咳,口疮肺痈。关数胃热,邪火上攻。尺数相火,遗浊淋癃。
兼脉 有力实火,无力虚火。浮数表热,沉数里热。阳数君火,阴数相火。右数火亢,左数阴戕。
【按】数之为义,躁急而不能中和也。一呼脉再动,气行三寸。一吸脉再动,气行三寸。呼吸定息,
气行六寸。一昼一夜,凡一万三千五百息,当五十周于身,脉行八百一十丈,此经脉周流恒常之揆度也。若一
息六至,岂非越其常度耶!火性急速,故阳盛之症,脉来必数也。伪诀云“七表八里”,而独遗数脉,只歌
于心脏,此其过非浅鲜也。数而弦急,则为紧脉。数而流利,则为滑脉。数而有止,则为促脉。数而过极,
则为疾脉。数如豆粒,则为动脉。古人云∶“脉书不厌千回读,熟读深思理自知。”只如相类之脉,非深思
不能辨别,非熟读不能谙识也。王叔和云∶“一呼再至曰平,三至曰离经,四至曰夺精,五至曰死,六至
曰命尽,此至之脉也。”乃知脉形愈数,则受症愈热矣。肺部见之,为金家贼脉;秋月逢之,为克令凶征也。
体象 滑脉替替,往来流利;盘珠之形,荷露之义。
主病 滑脉为阳,多主痰液。寸滑咳嗽,胸满吐逆。关滑胃热,壅气伤食。尺滑病淋,或为痢积;
男子溺血,妇人经郁。
兼脉 浮滑风痰,沉滑痰食。滑数痰火,滑短气塞。滑而浮大,尿则阴痛。滑而浮散,中风瘫缓。
滑而冲和,娠孕可决。
【按】滑之为义,往来流利而不涩滞也。阴气有余,故脉来流利如水。夫脉者,血之府也。血盛则脉滑,
故肾脉宜之。张仲景以翕奄沉为滑,而人莫能解。盖翕者,浮也。奄者,忽也。谓忽焉而沉,摩写往来流
利之状,极为曲至也。伪诀云∶“按之即伏,三关如珠,不进不退”,与滑
之名义,殊属支离。曰伏,曰不进不退,尤为怪诞。王叔和以关滑为胃
家有热,伪诀以关滑为胃家有寒,叔和以尺滑为下焦蓄血,伪诀以尺滑为脐下如冰,何相反悖谬一至此乎!
又考叔和云∶“与数相似”,则滑必兼数;而李时珍以滑为阴气有余,是何其不相合耶!或当以浮沉尺寸为
辨耳。滑脉为阳中之阴,以其形兼数也,故为阳;以其形如水也,故为阳中之阴。大抵兼浮者毗于阳,兼
沉者毗于阴,是以或热或寒,古无定称也。衡之以浮沉,辨之以尺寸,庶无误耳。
【体象】数脉属于阳脉,其形象表现为脉搏跳动过于急促;一呼一吸之间脉搏跳动六次,往来速度超越了正常限度。
【主病】数脉主要对应腑病,其病症性质为热证。寸部出现数脉,多见于气喘咳嗽、口舌生疮或肺痈;关部出现数脉,多为胃中有热,邪火上攻;尺部出现数脉,多为相火妄动,导致遗精、小便浑浊、淋证或尿闭。
【兼脉】若数脉有力,主实火;若数脉无力,主虚火。浮而数的脉象主表热,沉而数的脉象主里热。阳数(指上部或整体偏阳)多对应君火,阴数(指下部或整体偏阴)多对应相火。右脉数表示火气亢盛,左脉数表示阴液受损。
【按语】“数”字的含义,是指脉搏躁动急迫而不能保持中和平稳的状态。人一呼气时脉搏跳动两次,气血运行三寸;一吸气时脉搏跳动两次,气血运行三寸。在一呼一吸交替的间歇期,气血共运行六寸。一昼夜之间,人呼吸一万三千五百次,气血在体内循环五十周,脉行八百一十丈,这是经脉气血周流不息的正常度量标准。如果一息脉搏跳动六次,难道不是超越了正常的限度吗!火的性质急速,所以在阳气亢盛的病症中,脉象必然表现为数脉。伪诀《脉诀》中将脉分为“七表八里”,却唯独遗漏了数脉,只在心脏脉象的歌诀中提及,这种错误不可谓不深重。数脉且弦急的,就是紧脉;数脉且流利圆滑的,就是滑脉;数脉且有间歇停顿的,就是促脉;数脉且极度快速的,就是疾脉;数脉且如豆粒般动摇不定的,就是动脉。古人说:“读脉书不厌其烦地反复阅读,熟读并深入思考,其中的道理自然明了。”就像这些相似的脉象,不深入思考就无法辨别,不熟读就无法熟练掌握。王叔和说:“一呼脉搏跳动两次称为平脉,三次称为离经脉,四次称为夺精脉,五次称为死脉,六次称为命尽脉,这是根据至数来分类的。”由此可知,脉形越数,所对应的病症热势就越重。如果在肺部诊得此脉,是金脏(肺属金)的贼脉;若在秋季遇到此脉,是克制当令之气(秋属金)的凶险征象。
【体象】滑脉跳动连续不断,往来流利顺畅;其形态如同盘中滚动的珠子,又似荷叶上滚动的露珠。
【主病】滑脉属于阳脉,多主痰饮湿浊之证。寸部出现滑脉,多见于咳嗽、胸中胀满、呕吐逆气;关部出现滑脉,多为胃热、气机壅滞或伤食;尺部出现滑脉,病多为淋证,或为痢疾积聚;男子可能出现尿血,妇人可能出现月经郁滞。
【兼脉】浮滑脉主风痰,沉滑脉主痰食内停。滑数脉主痰火,滑短脉主气机阻塞。滑脉兼见浮大,排尿时阴部疼痛。滑脉兼见浮散,多见于中风导致的肢体瘫痪缓纵。滑脉兼见冲和之象,可判断为妊娠。
【按语】“滑”字的含义,是指脉搏往来流利而没有涩滞感。阴气有余,所以脉象往来流利如水。脉是血液汇聚的地方,血液充盛则脉象滑利,所以肾脉宜见滑象。张仲景用“翕奄沉”来形容滑脉,但人们往往不能理解。“翕”意为浮,“奄”意为忽。意思是忽然下沉,生动描绘了往来流利的状态,极其细致入微。伪诀《脉诀》中说:“按之即伏,三关如珠,不进不退”,这与滑脉的名义完全背离。说“伏”,说“不进不退”,尤其显得荒诞不经。王叔和认为关部滑脉是胃家有热,而伪诀《脉诀》认为关部滑脉是胃家有寒;王叔和认为尺部滑脉是下焦蓄血,而伪诀《脉诀》认为尺部滑脉是脐下冷如冰,为何相反悖谬到了这种地步!又考证王叔和说:“滑脉与数脉相似”,那么滑脉必定兼有数象;而李时珍认为滑脉是阴气有余,这二者为何不相吻合呢?或许应当通过浮沉和尺寸来加以辨别罢了。滑脉被称为“阳中之阴”,因为其形态兼有数象,所以为阳;因为其形态如水,所以为阳中之阴。大抵而言,兼见浮象的偏向于阳,兼见沉象的偏向于阴,因此有的主热有的主寒,古代没有固定的称呼。衡量其浮沉,辨别其尺寸,这样才不会有误。
[Body and Image] The Shu pulse (Rapid Pulse) belongs to Yang; its image manifests as excessive speed. In one respiration cycle, the pulse beats six times, moving back and forth beyond the normal limit.
[Main Diseases] The Shu pulse primarily indicates Fu-organ diseases, with the pathology being Heat. A Shu pulse at the Cun position is associated with wheezing and coughing, mouth ulcers, or lung abscesses. A Shu pulse at the Guan position indicates Stomach Heat, with pathogenic Fire attacking upward. A Shu pulse at the Chi position suggests Hyperactive Ministerial Fire, leading to seminal emission, turbid urination, strangury, or urinary retention.
[Combined Pulses] If the Shu pulse is forceful, it indicates Excess Fire; if it is weak, it indicates Deficiency Fire. A Floating-Shu pulse indicates Exterior Heat; a Deep-Shu pulse indicates Interior Heat. Yang-Shu corresponds to Sovereign Fire; Yin-Shu corresponds to Ministerial Fire. A Shu pulse on the Right side indicates Fire hyperactivity; a Shu pulse on the Left side indicates Yin damage.
[Commentary] The meaning of "Shu" (Rapid) is restlessness and urgency without maintaining balance and harmony. Upon one exhalation, the pulse moves twice, and Qi travels three cun. Upon one inhalation, the pulse moves twice, and Qi travels three cun. During the pause between respiration cycles, Qi travels six cun. In a day and night, there are 13,500 respiration cycles, during which Qi circulates fifty times through the body, traveling 810 zhang in the vessels. This is the constant measure of the normal circulation of meridians and vessels. If the pulse beats six times per respiration cycle, does this not exceed the normal limit? The nature of Fire is swift and urgent; therefore, in conditions of Yang excess, the pulse must be rapid. The spurious *Mai Jue* (Pulse Canon) classifies pulses into "Seven Superficial and Eight Interior," yet uniquely omits the Shu pulse, mentioning it only in the song for the Heart. This error is profound. A Shu pulse that is also wiry and tight is a Jin pulse (Tight Pulse). A Shu pulse that is smooth and slippery is a Hua pulse (Slippery Pulse). A Shu pulse that has pauses is a Cu pulse (Hasty Pulse). A Shu pulse that reaches extreme speed is a Ji pulse (Extreme Rapid Pulse). A Shu pulse that resembles a bean grain is a Dong pulse (Agitated Pulse). The ancients said: "One should not tire of reading pulse books repeatedly; by reading them thoroughly and thinking deeply, the principles will become clear." For such similar pulses, deep thought is required to distinguish them, and thorough reading is required to master them. Wang Shuhe stated: "Two beats per respiration is a Normal pulse; three beats is a Li Jing pulse (Departing from the Canon); four beats is a Duo Jing pulse (Depleting Essence); five beats is a Si pulse (Death); six beats is a Ming Jin pulse (End of Life), based on the number of beats." Thus, we know that the more rapid the pulse form, the hotter the corresponding disease. If seen in the Lung region, it is a "Thief Pulse" for the Metal organ; if encountered in Autumn, it is an ominous sign of overcoming the commanding seasonal Qi.
[Body and Image] The Hua pulse (Slippery Pulse) flows continuously and smoothly back and forth; its shape is like pearls rolling on a plate, or like dewdrops on lotus leaves.
[Main Diseases] The Hua pulse is a Yang pulse, mostly indicating Phlegm and fluid retention. A Hua pulse at the Cun position is associated with coughing, chest fullness, and vomiting/regurgitation. A Hua pulse at the Guan position indicates Stomach Heat, qi stagnation, or food retention. A Hua pulse at the Chi position is associated with strangury disease, or dysentery and accumulations; in men, it may indicate hematuria; in women, menstrual stagnation.
[Combined Pulses] A Floating-Hua pulse indicates Wind-Phlegm; a Deep-Hua pulse indicates Phlegm-Food retention. A Hua-Shu pulse indicates Phlegm-Fire; a Hua-Duan pulse indicates Qi obstruction. A Hua pulse combined with Floating and Large indicates pain in the yin organs during urination. A Hua pulse combined with Floating and Scattered indicates wind-stroke leading to paralysis and flaccidity. A Hua pulse combined with a harmonious and vigorous quality can determine pregnancy.
[Commentary] The meaning of "Hua" (Slippery) is smooth flow without涩滞 (stagnation/roughness). When Yin Qi is in excess, the pulse comes smoothly like water. The pulse is the residence of Blood; when Blood is abundant, the pulse is slippery, so the Kidney pulse appropriately exhibits this quality. Zhang Zhongjing described the Hua pulse as "Xi Yan Chen" (fluctuating and suddenly sinking), but people often fail to understand it. "Xi" means floating; "Yan" means suddenly. It refers to suddenly sinking, vividly depicting the state of smooth flow, extremely detailed and precise. The spurious *Mai Jue* states: "Pressing makes it sink, the three positions resemble pearls, neither advancing nor retreating." This is completely disjointed from the name and meaning of the Hua pulse. To say it "sinks" or "neither advances nor retreats" is particularly absurd. Wang Shuhe considered Guan-Hua as Heat in the Stomach, while the spurious *Mai Jue* considered Guan-Hua as Cold in the Stomach; Wang Shuhe considered Chi-Hua as Blood stasis in the Lower Jiao, while the spurious *Mai Jue* considered Chi-Hua as cold below the navel like ice. How opposite and erroneous they are! Furthermore, examining Wang Shuhe's statement: "Similar to the Shu pulse," implies that Hua must combine with Shu; whereas Li Shizhen regarded Hua as excess Yin Qi. Why do they not coincide? Perhaps differentiation should be made based on Floating/Deep and Cun/Guan/Chi positions. The Hua pulse is called "Yang within Yin" because its form combines with Shu (Rapid), thus it is Yang; because its form is like water, thus it is Yang within Yin. Generally, those combining with Floating lean towards Yang, and those combining with Deep lean towards Yin; therefore, some indicate Heat and some indicate Cold, with no fixed designation in ancient texts. By weighing Floating/Deep and distinguishing Cun/Guan/Chi, errors can be avoided.