数脉息数辐辏按举有力主阳盛燔灼侵剥真阴之实病。浮为在表沉为在里发表攻里。脉症
相符
。不难治也。而独有如数之脉。疑似真假之间便有生死。霄壤之殊。人多不知也。夫数按不
鼓
则为虚寒相搏之。脉数大而虚则为精血销竭之脉细疾。若数阴燥似阳之候也。沉弦细数虚
痨垂死之期也。又有快脉即疾脉。快疾即如数脉。非真数也。若假热之病。误服凉剂。脉亦见
数也。每见
举世医流。诊得息数急疾。竟不知新病久病有力无力鼓与不鼓之异。一概混投苦寒。遽绝胃
气。安得不速人于死乎。徐东皋云∶数候多凶。匀健略可。惟宜伤寒妊疟小儿。濒湖脉学云
∶数脉为阳热可知。只将君相火来医。实宜凉泻虚温补。肺病秋深却畏之。据此亦尝有温
补之者矣。若仅言只将君相火来医。则犹见之。未扩也夫独不有阳虚阴盛之重恙。反得洪数
有力
之实脉。急温桂附。旋即痊可者乎。余谨再引内经色脉篇论。以正其谬。以救其枉。为时师
下一痛针法。经言冬脉曰∶其气来如弹石者。此为太过。病在外。其去如数者。此为不及。
病在中。释云∶来如弹石者其至坚强。营之太过也。去如数者动止疾促。营之不及也。盖数
本属热而此真阴亏损之。脉亦必急数然。愈数则愈虚。愈虚则愈数。而非阳强实热之。数故
不曰。数而曰如数则辨柝之。意深矣。此而一瘥。生死反掌。愚以为何独数脉有相似者。即
浮沉迟缓滑涩虚实弦紧诸脉。亦皆有相似也。又非唯脉然也。至症若如疟如痰如喘如风如淋
等
病。设非素娴审辨。临事最撼心目。故庸浅者只知现下。精妙者疑似独明为医之难。政此关
头矣。
数脉表现为呼吸次数增多，脉搏急促有力，主要主阳气亢盛、火热炽盛而灼伤真阴的实证。浮脉主病在表，沉脉主病在里，通过发汗解表或攻下治里，若脉象与症状相符，则不难治疗。然而唯独出现数脉时，往往处于疑似真假难辨之间，此时生死之别犹如天壤，世人大多不了解这一点。如果按之无力（不鼓），则是虚寒相搏结所致；脉象数大而虚弱，则是精血枯竭的表现；脉象细而疾速，则是阴虚内燥似有阳热的征候；脉象沉弦细数，则是虚劳病接近死亡的征兆。又有“快脉”即“疾脉”，快疾脉类似于数脉，但并非真正的数脉。如果是假热证的患者，误服了寒凉药剂，脉象也会呈现数象。常常见到世间医生，诊察发现脉搏急疾，却不知区分新病久病、有力无力以及按之是否鼓指的区别，一概混投苦寒药物，迅速断绝胃气，怎么能不加速病人死亡呢？徐东皋说：数脉多主凶险，只有均匀健壮尚可。唯独适宜用于伤寒、妊娠疟疾和小儿疾病。李时珍《濒湖脉学》说：数脉属阳热可知，只需将君火和相火来医治。实证适宜用凉泻法，虚证适宜用温补法。肺病到了深秋时节却畏惧数脉。据此也有使用温补法的了。如果说仅仅只用君相火来医治，那见解尚浅，未能扩充。难道没有阳虚阴盛的危重病症，反而出现洪大数而有力的实脉，急需温补并用桂枝、附子，随即痊愈的情况吗？我谨慎地再次引用《内经·色脉篇》的论述，以纠正其谬误，挽救被误治者，为当时的医生下一剂痛针。经文说：冬季的脉象称为：其来势像弹石一样坚硬，这叫做太过，病在体表；其去势像数脉（急促）一样，这叫做不及，病在体内。解释说：来势像弹石，说明脉至坚实强劲，是营气太过；去势像数脉，说明动止疾促，是营气不及。大概数脉本属于热证，但此处是真阴亏损的脉象也必然急数。越数则越虚，越虚则越数，而不是阳气强盛实热的数脉。所以不说“数”，而说“如数”，其中的辨析之意很深了。这种情况一旦好转，生死就在反掌之间。我认为何止数脉有相似的脉象，即浮、沉、迟、缓、滑、涩、虚、实、弦、紧等诸脉，也都有相似之处。又不只是脉象如此，至于症状，诸如像疟疾、像痰饮、像喘证、像中风、像淋证等疾病，如果不是平时精通审辨，临事最易动摇心神。所以庸俗浅薄的人只知道眼前的表象，精妙之人则在疑似中独能明辨，这就是行医的难点，正在于这个关头啊。
The Shu Mai (Rapid Pulse) is characterized by a rapid respiratory and pulse rate, feeling forceful upon pressing and lifting. It primarily indicates an excess condition where Yang Qi is hyperactive, fire is blazing, and consuming the True Yin. A Floating pulse indicates disease in the Exterior, while a Deep pulse indicates disease in the Interior; treating via diaphoresis for the Exterior or purgation for the Interior, if the pulse matches the symptoms, treatment is not difficult. However, when only a Rapid pulse appears, it often falls into a realm of suspicion between true and false, where the difference between life and death is as vast as heaven and earth, yet most people do not understand this. If the pulse feels weak upon pressure (not drumming), it is caused by the interplay of deficiency and cold; a Rapid, large, and deficient pulse indicates the depletion of Essence and Blood; a fine and rapid pulse indicates Yin deficiency with dryness resembling Yang heat; a Deep, wiry, fine, and rapid pulse indicates the critical stage of consumptive disease approaching death. There is also the Kuai Mai (Fast Pulse), which is synonymous with the Ji Mai (Hasty Pulse); the Fast/Hasty pulse resembles the Rapid pulse but is not truly Rapid. In cases of false heat, if cooling agents are mistakenly administered, the pulse may also appear Rapid. It is common to see physicians in the world who, upon detecting a rapid and hasty pulse, fail to distinguish between new and old diseases, strength and weakness, and whether the pulse drums under pressure. They indiscriminately administer bitter-cold herbs, abruptly destroying Stomach Qi, how can they not hasten the patient to death? Xu Donggao stated: "Rapid pulses mostly indicate ominous signs; only if uniform and robust is it acceptable. It is suitable only for Shanghan (Cold Damage), pregnancy-related malaria, and pediatric cases." Li Shizhen's Binhu Maixue (Pulse Studies from Binhu) states: "Rapid pulses belong to Yang Heat, known clearly; one should treat using Ministerial Fire and Sovereign Fire. Excess conditions suit cooling purgation, while deficiency suits warming tonification. For Lung disease in late autumn, one fears it." Based on this, there have been instances of using warming tonification. If one merely says to treat using Ministerial and Sovereign Fire, the insight is still shallow and unexpanded. Are there not severe cases of Yang deficiency and Yin excess that present with a洪 (Surging), Rapid, and forceful excess pulse, requiring urgent warming with Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root), resulting in immediate recovery? I cautiously cite again the discussion from the Seimen and Maixian chapters of Neijing (Inner Canon) to correct these errors and save those wrongly treated, delivering a painful needle to contemporary physicians. The Classic states regarding Winter pulses: "When the Qi comes like a flicking stone, this is called Excess, disease is in the Exterior; when it goes like a Rapid pulse, this is called Deficiency, disease is in the Interior." The explanation clarifies: "Coming like a stone means the arrival is firm and strong, indicating Excess of Ying (Nutritive) Qi; going like a Rapid pulse means movement and cessation are hurried, indicating Deficiency of Ying Qi." Generally, Rapid pulses belong to Heat, but here, due to True Yin deficiency, the pulse must also be hurriedly Rapid. The more Rapid, the more deficient; the more deficient, the more Rapid; this is not the Rapid pulse of Yang hyperactivity and excess Heat. Thus, it does not say "Rapid" but "Like Rapid," implying deep diagnostic discernment. If this condition improves even slightly, life and death hang in the balance. I believe it is not only the Rapid pulse that has similar counterparts; all other pulses such as Floating, Deep, Slow, Moderate, Slippery, Choppy, Deficient, Excess, Wiry, and Tight also have similarities. Nor is it only the pulse that is so; regarding symptoms, diseases resembling Malaria, Phlegm, Asthma, Wind Stroke, and Lin Syndrome, unless one is proficient in careful differentiation, these situations most easily shake the mind and eyes at the moment of practice. Therefore, mediocre and superficial practitioners only know the present appearance, while refined practitioners uniquely clarify the suspicious aspects. This difficulty in medicine lies precisely at this juncture.