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中醫脈象之微脈

祝由網 2023-11-13 12:56:37

微(wei)脈(mo)(mo)亦(yi)是(shi)一個具(ju)有復合因素(su)的(de)脈(mo)(mo)象(xiang)。它(ta)具(ju)有細、無力(li)與模糊不(bu)清若有若無的(de)幾種條件,仲景(jing)書言微(wei)脈(mo)(mo)之處已經不(bu)少,但(dan)(dan)對(dui)脈(mo)(mo)形亦(yi)未正式涉(she)及,后(hou)人以《傷(shang)寒論(lun)·辨脈(mo)(mo)法》有“脈(mo)(mo)瞥(pie)(pie)瞥(pie)(pie)如(ru)(ru)羹(geng)上肥者,陽(yang)氣(qi)微(wei)也(ye)”,認為(wei)(wei)就是(shi)微(wei)脈(mo)(mo),但(dan)(dan)尋繹(yi)文義這是(shi)說病理是(shi)陽(yang)氣(qi)微(wei),不(bu)能即以此作為(wei)(wei)微(wei)脈(mo)(mo),但(dan)(dan)《傷(shang)寒論(lun)·平(ping)脈(mo)(mo)法》又說:“寸口諸微(wei)亡陽(yang),諸濡亡血……”對(dui)勘兩(liang)段經文,可(ke)以將瞥(pie)(pie)瞥(pie)(pie)如(ru)(ru)羹(geng)上肥作為(wei)(wei)微(wei)脈(mo)(mo)的(de)參考條件。仲

景所言(yan)之(zhi)(zhi)(zhi)微(wei)脈(mo)(mo)未必都(dou)是(shi)(shi)(shi)極(ji)危重之(zhi)(zhi)(zhi)證(文不(bu)錄),但(dan)確有(you)一部分是(shi)(shi)(shi)屬于亡陽重證,或陽氣方回(hui)的(de)脈(mo)(mo),如(ru):“少陰病,下(xia)利脈(mo)(mo)微(wei)者與(yu)白(bai)通(tong)湯(tang)(tang),利不(bu)止,厥(jue)逆(ni)無(wu)脈(mo)(mo),干嘔(ou)煩(fan)者,白(bai)通(tong)加豬膽汁湯(tang)(tang)主之(zhi)(zhi)(zhi)。服湯(tang)(tang)脈(mo)(mo)暴出者死,微(wei)續者生。“少陰病下(xia)利諸谷(gu),里寒外熱,手(shou)足厥(jue)逆(ni),脈(mo)(mo)微(wei)欲(yu)絕(jue)”“通(tong)脈(mo)(mo)四逆(ni)湯(tang)(tang)主之(zhi)(zhi)(zhi)。”可見(jian)亡陽重證當(dang)見(jian)微(wei)或脈(mo)(mo)微(wei)欲(yu)絕(jue)脈(mo)(mo),如(ru)果在原先無(wu)脈(mo)(mo)的(de)情(qing)況(kuang)下(xia)經過治療(liao),脈(mo)(mo)微(wei)續則是(shi)(shi)(shi)生機(ji),這(zhe)種脈(mo)(mo)是(shi)(shi)(shi)由于無(wu)而(er)漸有(you)的(de),既細、弱(ruo)又模糊(hu)不(bu)清若有(you)若無(wu)的(de)脈(mo)(mo),這(zhe)應當(dang)說(shuo)(shuo)是(shi)(shi)(shi)典型的(de)微(wei)脈(mo)(mo),至于李時(shi)珍說(shuo)(shuo):“《素問》謂之(zhi)(zhi)(zhi)小。”則古(gu)人說(shuo)(shuo)脈(mo)(mo)尚不(bu)十分嚴格或有(you)此(ci)意,但(dan)不(bu)能認(ren)為就(jiu)是(shi)(shi)(shi)仲景而(er)下(xia)說(shuo)(shuo)的(de)典型的(de)微(wei)脈(mo)(mo)。

對微(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)提(ti)出明確(que)脈(mo)(mo)(mo)(mo)(mo)(mo)形(xing)的(de)(de)(de)是(shi)《脈(mo)(mo)(mo)(mo)(mo)(mo)經(jing)(jing)》:“極(ji)細(xi)(xi)(xi)而(er)軟(ruan)(ruan),或欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)。”“一(yi)日小(xiao)(xiao)也,一(yi)曰手(shou)下快,一(yi)日浮(fu)(fu)而(er)薄(bo),一(yi)日按(an)之(zhi)(zhi)如(ru)(ru)(ru)(ru)(ru)欲(yu)(yu)(yu)盡。”從《脈(mo)(mo)(mo)(mo)(mo)(mo)經(jing)(jing)》引(yin)(yin)用的(de)(de)(de)多種不(bu)(bu)(bu)(bu)同說(shuo)(shuo)(shuo)(shuo)(shuo)法,及“正文(wen)”所確(que)定的(de)(de)(de)脈(mo)(mo)(mo)(mo)(mo)(mo)形(xing)來(lai)看(kan),在(zai)(zai)王(wang)叔(shu)和(he)以前微(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)的(de)(de)(de)認識是(shi)很不(bu)(bu)(bu)(bu)一(yi)致的(de)(de)(de)。而(er)通過前此和(he)以后的(de)(de)(de)實踐證明《脈(mo)(mo)(mo)(mo)(mo)(mo)經(jing)(jing)》提(ti)出的(de)(de)(de)根細(xi)(xi)(xi)軟(ruan)(ruan)如(ru)(ru)(ru)(ru)(ru)欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)是(shi)合理(li)的(de)(de)(de),《脈(mo)(mo)(mo)(mo)(mo)(mo)經(jing)(jing)》的(de)(de)(de)說(shuo)(shuo)(shuo)(shuo)(shuo)法得到歷代(dai)絕(jue)(jue)(jue)(jue)(jue)大(da)多數學者(zhe)(zhe)的(de)(de)(de)支持(chi),并繼(ji)承了(le)(le)這(zhe)種標(biao)準,例(li)如(ru)(ru)(ru)(ru)(ru)《千余方》引(yin)(yin)用了(le)(le)《脈(mo)(mo)(mo)(mo)(mo)(mo)經(jing)(jing)》全文(wen)。《千金翼方》說(shuo)(shuo)(shuo)(shuo)(shuo):“按(an)之(zhi)(zhi)短小(xiao)(xiao)不(bu)(bu)(bu)(bu)至(zhi),動(dong)搖,若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),或復(fu)浮(fu)(fu)薄(bo)而(er)細(xi)(xi)(xi)急,輕(qing)手(shou)乃(nai)得,重(zhong)手(shou)不(bu)(bu)(bu)(bu)得,名日微(wei)(wei)(wei)(wei)(wei)。”《脈(mo)(mo)(mo)(mo)(mo)(mo)訣(jue)》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)者(zhe)(zhe)陰也,指(zhi)下尋之(zhi)(zhi),往(wang)來(lai)極(ji)微(wei)(wei)(wei)(wei)(wei),冉(ran)冉(ran)尋之(zhi)(zhi),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)。”《活人書》說(shuo)(shuo)(shuo)(shuo)(shuo):“若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),極(ji)細(xi)(xi)(xi)而(er)軟(ruan)(ruan)。”崔紫虛(xu)《脈(mo)(mo)(mo)(mo)(mo)(mo)訣(jue)》說(shuo)(shuo)(shuo)(shuo)(shuo):“隱(yin)隱(yin)約(yue)約(yue)微(wei)(wei)(wei)(wei)(wei)渺難尋。”《察病指(zhi)南》說(shuo)(shuo)(shuo)(shuo)(shuo):“指(zhi)下尋之(zhi)(zhi),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),極(ji)細(xi)(xi)(xi)而(er)浮(fu)(fu)軟(ruan)(ruan),往(wang)來(lai)如(ru)(ru)(ru)(ru)(ru)秋風(feng)吹毛(mao)而(er)無(wu)(wu)(wu)(wu)(wu)力(li)。”《診(zhen)家(jia)樞要(yao)》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei),不(bu)(bu)(bu)(bu)顯也。依稀輕(qing)微(wei)(wei)(wei)(wei)(wei),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)。”《難經(jing)(jing)集注(zhu)》引(yin)(yin)楊玄提(ti)說(shuo)(shuo)(shuo)(shuo)(shuo):“按(an)之(zhi)(zhi)短小(xiao)(xiao),不(bu)(bu)(bu)(bu)動(dong)搖,若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),輕(qing)手(shou)乃(nai)得,重(zhong)手(shou)不(bu)(bu)(bu)(bu)得,謂之(zhi)(zhi)微(wei)(wei)(wei)(wei)(wei)也。”戴啟宗(zong)《脈(mo)(mo)(mo)(mo)(mo)(mo)訣(jue)刊(kan)誤》說(shuo)(shuo)(shuo)(shuo)(shuo):“欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue)非絕(jue)(jue)(jue)(jue)(jue),又(you)日,按(an)之(zhi)(zhi)如(ru)(ru)(ru)(ru)(ru)欲(yu)(yu)(yu)盡。”丹(dan)溪《脈(mo)(mo)(mo)(mo)(mo)(mo)訣(jue)指(zhi)掌》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)者(zhe)(zhe),極(ji)細(xi)(xi)(xi)而(er)軟(ruan)(ruan),似(si)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)。”《醫(yi)(yi)經(jing)(jing)小(xiao)(xiao)學》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)來(lai)如(ru)(ru)(ru)(ru)(ru)有(you)(you)(you)(you)(you)又(you)如(ru)(ru)(ru)(ru)(ru)無(wu)(wu)(wu)(wu)(wu)。”《醫(yi)(yi)學人門》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)似(si)蛛絲(si)容易(yi)斷。”這(zhe)是(shi)不(bu)(bu)(bu)(bu)對的(de)(de)(de),因為如(ru)(ru)(ru)(ru)(ru)蛛絲(si)是(shi)細(xi)(xi)(xi)不(bu)(bu)(bu)(bu)是(shi)微(wei)(wei)(wei)(wei)(wei),但隨(sui)即他(ta)就(jiu)作了(le)(le)如(ru)(ru)(ru)(ru)(ru)下的(de)(de)(de)補(bu)充(chong)說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)不(bu)(bu)(bu)(bu)顯也,若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)。”由于微(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)本來(lai)就(jiu)含有(you)(you)(you)(you)(you)細(xi)(xi)(xi)脈(mo)(mo)(mo)(mo)(mo)(mo)的(de)(de)(de)成分,所以《醫(yi)(yi)學人門》的(de)(de)(de)說(shuo)(shuo)(shuo)(shuo)(shuo)法在(zai)(zai)表(biao)達(da)上不(bu)(bu)(bu)(bu)應當分開,但總起來(lai)講還是(shi)將內容表(biao)達(da)出來(lai)了(le)(le)。《太素(su)脈(mo)(mo)(mo)(mo)(mo)(mo)秘訣(jue)》說(shuo)(shuo)(shuo)(shuo)(shuo):“輕(qing)虛(xu)細(xi)(xi)(xi)軟(ruan)(ruan),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)。”“微(wei)(wei)(wei)(wei)(wei)者(zhe)(zhe)最(zui)細(xi)(xi)(xi)而(er)弱,重(zhong)指(zhi)尋之(zhi)(zhi),宛然如(ru)(ru)(ru)(ru)(ru)毛(mao)發,隱(yin)隱(yin)澀(se)澀(se)疑不(bu)(bu)(bu)(bu)可狀(zhuang),在(zai)(zai)于有(you)(you)(you)(you)(you)無(wu)(wu)(wu)(wu)(wu)間(jian)。”李時珍《瀕湖脈(mo)(mo)(mo)(mo)(mo)(mo)學》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)極(ji)細(xi)(xi)(xi)而(er)軟(ruan)(ruan),按(an)之(zhi)(zhi)如(ru)(ru)(ru)(ru)(ru)欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),細(xi)(xi)(xi)而(er)稍長(chang)。”《脈(mo)(mo)(mo)(mo)(mo)(mo)語(yu)》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei),脈(mo)(mo)(mo)(mo)(mo)(mo)來(lai)極(ji)細(xi)(xi)(xi)而(er)軟(ruan)(ruan),或欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue),若(ruo)(ruo)(ruo)(ruo)(ruo)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)也。”全文(wen)引(yin)(yin)用了(le)(le)《腑經(jing)(jing)》。《脈(mo)(mo)(mo)(mo)(mo)(mo)訣(jue)匯(hui)辨》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)極(ji)細(xi)(xi)(xi),而(er)又(you)極(ji)軟(ruan)(ruan),似(si)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu)欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue)非絕(jue)(jue)(jue)(jue)(jue)。”《醫(yi)(yi)宗(zong)必(bi)讀(du)》說(shuo)(shuo)(shuo)(shuo)(shuo):“無(wu)(wu)(wu)(wu)(wu)力(li),似(si)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),模(mo)(mo)糊難見矣(yi)。”《診(zhen)家(jia)正眼》說(shuo)(shuo)(shuo)(shuo)(shuo):“微(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)極(ji)細(xi)(xi)(xi),而(er)又(you)極(ji)軟(ruan)(ruan),似(si)有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue)非絕(jue)(jue)(jue)(jue)(jue)。”《診(zhen)宗(zong)三(san)昧(mei)》說(shuo)(shuo)(shuo)(shuo)(shuo):“但有(you)(you)(you)(you)(you)若(ruo)(ruo)(ruo)(ruo)(ruo)無(wu)(wu)(wu)(wu)(wu),欲(yu)(yu)(yu)絕(jue)(jue)(jue)(jue)(jue)非絕(jue)(jue)(jue)(jue)(jue),而(er)按(an)之(zhi)(zhi)稍有(you)(you)(you)(you)(you)模(mo)(mo)糊之(zhi)(zhi)狀(zhuang)。”可見《脈(mo)(mo)(mo)(mo)(mo)(mo)經(jing)(jing)》的(de)(de)(de)說(shuo)(shuo)(shuo)(shuo)(shuo)法是(shi)諸家(jia)所宗(zong)的(de)(de)(de)典則。

雖(sui)然有(you)人(ren)涉及了(le)浮、短、長、動搖(yao),不(bu)(bu)動搖(yao)等并非(fei)微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)所必具的(de)(de)(de)條(tiao)件稍有(you)概念不(bu)(bu)清之(zhi)(zhi)弊,但(dan)主要(yao)內容還都是(shi)(shi)(shi)正確的(de)(de)(de)一(yi)致的(de)(de)(de)。《脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)學輯(ji)要(yao)》引董西園日:“微(wei)為(wei)氣(qi)(qi)血(xue)不(bu)(bu)足(zu)之(zhi)(zhi)象,以指按(an)之(zhi)(zhi)似(si)有(you)如(ru)(ru)無(wu),衰敗(bai)(bai)之(zhi)(zhi)況也。凡脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)之(zhi)(zhi)不(bu)(bu)甚鼓(gu)指,脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)體(ti)損小(xiao)(xiao)者(zhe),即是(shi)(shi)(shi)微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo),若至有(you)無(wu)之(zhi)(zhi)間,模糊影響,證(zheng)(zheng)(zheng)(zheng)已(yi)敗(bai)(bai)矣,虛(xu)(xu)(xu)極(ji)之(zhi)(zhi)也。”意見(jian)是(shi)(shi)(shi)微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)有(you)程度(du)上(shang)(shang)的(de)(de)(de)不(bu)(bu)同(tong),這是(shi)(shi)(shi)誠然的(de)(de)(de),但(dan)說(shuo)不(bu)(bu)甚鼓(gu)指脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)體(ti)損小(xiao)(xiao)就算微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)未免(mian)條(tiao)件太(tai)低,因為(wei)那只(zhi)不(bu)(bu)過是(shi)(shi)(shi)細(xi)而無(wu)力的(de)(de)(de)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo),濡(ru)弱(ruo)之(zhi)(zhi)類。微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)是(shi)(shi)(shi)重證(zheng)(zheng)(zheng)(zheng)的(de)(de)(de)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo),必須有(you)不(bu)(bu)清不(bu)(bu)明之(zhi)(zhi)候(hou),否則與一(yi)般(ban)弱(ruo)小(xiao)(xiao)的(de)(de)(de)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)就無(wu)法分別了(le)。急證(zheng)(zheng)(zheng)(zheng)見(jian)微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)(如(ru)(ru)傷寒等)或(huo)(huo)可(ke)治(zhi)療,如(ru)(ru)久(jiu)病(bing)虛(xu)(xu)(xu)證(zheng)(zheng)(zheng)(zheng)雜證(zheng)(zheng)(zheng)(zheng)見(jian)到(dao)(dao)微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo),當然是(shi)(shi)(shi)敗(bai)(bai)證(zheng)(zheng)(zheng)(zheng),一(yi)般(ban)是(shi)(shi)(shi)無(wu)可(ke)挽(wan)回的(de)(de)(de),仲景(jing)在(zai)搶救少(shao)陰(yin)重證(zheng)(zheng)(zheng)(zheng)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)不(bu)(bu)至時有(you)微(wei)續者(zhe)生的(de)(de)(de)條(tiao)文,我們在(zai)臨(lin)床搶救病(bing)人(ren)時亦(yi)常見(jian)到(dao)(dao)微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo),它或(huo)(huo)是(shi)(shi)(shi)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)欲停的(de)(de)(de)先兆(zhao),或(huo)(huo)是(shi)(shi)(shi)停而搶救恢復開始(shi)時的(de)(de)(de)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)象,總之(zhi)(zhi)它是(shi)(shi)(shi)個極(ji)危(wei)重或(huo)(huo)瀕死前的(de)(de)(de)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)象,絕非(fei)虛(xu)(xu)(xu)弱(ruo)濡(ru)細(xi)等脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)可(ke)比。清·馬(ma)冠群《醫悟(wu)》說(shuo):“微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)更虛(xu)(xu)(xu),似(si)有(you)似(si)無(wu),極(ji)細(xi)極(ji)軟(ruan),氣(qi)(qi)弱(ruo)血(xue)枯。”“微(wei)則但(dan)有(you)浮中(zhong),并無(wu)沉候(hou)。”繼承(cheng)了(le)前人(ren)浮取之(zhi)(zhi)說(shuo),進(jin)一(yi)步斷(duan)言無(wu)沉候(hou),這在(zai)實(shi)踐中(zhong)是(shi)(shi)(shi)并不(bu)(bu)完全(quan)支持的(de)(de)(de)。臨(lin)床上(shang)(shang)危(wei)重病(bing)人(ren)沉取微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)亦(yi)不(bu)(bu)少(shao)見(jian)。《脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)論要(yao)篇(pian)》說(shuo):“微(wei)脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)縈(ying)縈(ying)如(ru)(ru)珠絲(si),瞥瞥如(ru)(ru)羹上(shang)(shang)肥,極(ji)細(xi)極(ji)軟(ruan),模糊難見(jian)。欲絕非(fei)絕似(si)有(you)若無(wu),氣(qi)(qi)血(xue)衰微(wei)之(zhi)(zhi)診(zhen)也。輕取之(zhi)(zhi)而如(ru)(ru)無(wu),故(gu)知陽氣(qi)(qi)衰,重按(an)之(zhi)(zhi)而欲絕,故(gu)知陰(yin)氣(qi)(qi)弱(ruo)。”將仲景(jing)《傷寒論·辨脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)法》與《脈(mo)(mo)(mo)(mo)(mo)(mo)(mo)經》之(zhi)(zhi)說(shuo)綜(zong)合在(zai)一(yi)起,較為(wei)全(quan)面。

總之(zhi)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)脈(mo)(mo)(mo)(mo)形(xing)(xing)一(yi)般都祖(zu)述仲景、叔和兩(liang)家,內容(rong)較為統一(yi)。微(wei)(wei)(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)脈(mo)(mo)(mo)(mo)形(xing)(xing)歷(li)代(dai)諸家亦有(you)部(bu)分(fen)(fen)人論述中存(cun)在一(yi)定不(bu)(bu)(bu)足或錯誤等(deng)問題,例如《外科精義》說(shuo):“微(wei)(wei)(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)之(zhi)診,按(an)之(zhi)則軟(ruan)小極(ji)微(wei)(wei)(wei)(wei)(wei)(wei)(wei),其(qi)主虛也(ye):”論述不(bu)(bu)(bu)清(qing),亦未(wei)及若(ruo)有(you)若(ruo)無等(deng)主要條件,有(you)些書則論述不(bu)(bu)(bu)切,例如《四(si)言舉要》與《新四(si)言脈(mo)(mo)(mo)(mo)訣》說(shuo):“濡甚(shen)(shen)則微(wei)(wei)(wei)(wei)(wei)(wei)(wei),不(bu)(bu)(bu)任尋(xun)按(an)。”濡甚(shen)(shen)仍(reng)然(ran)(ran)是(shi)(shi)濡不(bu)(bu)(bu)能質變(bian)為微(wei)(wei)(wei)(wei)(wei)(wei)(wei)《景岳全(quan)書》說(shuo):“纖細(xi)(xi)(xi)(xi)無神(shen),柔弱(ruo)之(zhi)極(ji),是(shi)(shi)為陰脈(mo)(mo)(mo)(mo)。”這仍(reng)是(shi)(shi)細(xi)(xi)(xi)(xi)弱(ruo)而不(bu)(bu)(bu)是(shi)(shi)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)。《醫(yi)學心悟》說(shuo):“微(wei)(wei)(wei)(wei)(wei)(wei)(wei),細(xi)(xi)(xi)(xi)而隱也(ye)。”不(bu)(bu)(bu)夠清(qing)楚。《醫(yi)碥》說(shuo):“細(xi)(xi)(xi)(xi)甚(shen)(shen),無力(li)(li)為微(wei)(wei)(wei)(wei)(wei)(wei)(wei)。”說(shuo):“古以(yi)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)屬浮分(fen)(fen),細(xi)(xi)(xi)(xi)屬沉分(fen)(fen),微(wei)(wei)(wei)(wei)(wei)(wei)(wei)為陽(yang)衰,細(xi)(xi)(xi)(xi)為血少(shao)。”細(xi)(xi)(xi)(xi)甚(shen)(shen)無力(li)(li)還是(shi)(shi)細(xi)(xi)(xi)(xi),不(bu)(bu)(bu)應(ying)當算(suan)微(wei)(wei)(wei)(wei)(wei)(wei)(wei),浮沉對(dui)應(ying)是(shi)(shi)濡與弱(ruo),不(bu)(bu)(bu)是(shi)(shi)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)與細(xi)(xi)(xi)(xi)。《沈(shen)氏尊生書》說(shuo):“遲(chi)而細(xi)(xi)(xi)(xi)軟(ruan)為微(wei)(wei)(wei)(wei)(wei)(wei)(wei)。”當然(ran)(ran)亦是(shi)(shi)不(bu)(bu)(bu)對(dui)的。《辨(bian)脈(mo)(mo)(mo)(mo)篇》說(shuo):“微(wei)(wei)(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)浮而極(ji)小極(ji)軟(ruan),過甚(shen)(shen)于(yu)濡。”弊(bi)與前(qian)《四(si)言舉要》等(deng)相(xiang)同。《脈(mo)(mo)(mo)(mo)學輯要》引嚴三點說(shuo):“微(wei)(wei)(wei)(wei)(wei)(wei)(wei)如蜘蛛(zhu)之(zhi)度微(wei)(wei)(wei)(wei)(wei)(wei)(wei)絲,按(an)之(zhi)無力(li)(li)而動搖。”這仍(reng)然(ran)(ran)是(shi)(shi)細(xi)(xi)(xi)(xi)脈(mo)(mo)(mo)(mo)。在形(xing)(xing)容(rong)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)時若(ruo)用蛛(zhu)絲與羹上肥并列是(shi)(shi)可以(yi)的。因(yin)為前(qian)者形(xing)(xing)容(rong)其(qi)細(xi)(xi)(xi)(xi),后者形(xing)(xing)容(rong)其(qi)不(bu)(bu)(bu)定,但(dan)只用蛛(zhu)絲形(xing)(xing)容(rong)就不(bu)(bu)(bu)對(dui),因(yin)為微(wei)(wei)(wei)(wei)(wei)(wei)(wei)雖有(you)細(xi)(xi)(xi)(xi)的成(cheng)分(fen)(fen),卻不(bu)(bu)(bu)是(shi)(shi)只有(you)細(xi)(xi)(xi)(xi)的成(cheng)分(fen)(fen),《診家直訣》說(shuo):“薄浮而散,微(wei)(wei)(wei)(wei)(wei)(wei)(wei)也(ye)。”顯然(ran)(ran)亦是(shi)(shi)不(bu)(bu)(bu)對(dui)的。另外《醫(yi)學探驪》說(shuo):“微(wei)(wei)(wei)(wei)(wei)(wei)(wei)與細(xi)(xi)(xi)(xi)對(dui)以(yi)部(bu)位言微(wei)(wei)(wei)(wei)(wei)(wei)(wei)脈(mo)(mo)(mo)(mo)浮取(qu)郎得(de),應(ying)指(zhi)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)微(wei)(wei)(wei)(wei)(wei)(wei)(wei)無力(li)(li),若(ruo)重按(an)尺部(bu),尚可有(you)脈(mo)(mo)(mo)(mo),寸關部(bu)位則不(bu)(bu)(bu)能也(ye)。”

向來脈(mo)(mo)書并不以寸關尺之(zhi)有無論(lun)微脈(mo)(mo),康(kang)應良氏此說為(wei)獨創(chuang),但亦(yi)有實踐根據(ju)(ju),這正是說病(bing)人(ren)頻死脈(mo)(mo)絕(jue)前之(zhi)情況,由微而(er)至絕(jue)的過程(cheng),先從寸關脈(mo)(mo)絕(jue)不至,經脈(mo)(mo)已不能行于(yu)四末(mo),尺脈(mo)(mo)則仍(reng)(reng)可見到微脈(mo)(mo),繼之(zhi)尺脈(mo)(mo)亦(yi)絕(jue),于(yu)尺澤仍(reng)(reng)可見到微脈(mo)(mo),再進(jin)則尺澤亦(yi)無脈(mo)(mo),心跳當(dang)即于(yu)此時間或稍后停止。故而(er)《醫學探驪》此說確可補(bu)古人(ren)之(zhi)所(suo)未及。根據(ju)(ju)歷(li)史文(wen)獻及對(dui)其分析考證,結(jie)合臨床實踐、實驗(yan)等經驗(yan)體會,擬訂(ding)微脈(mo)(mo)的傳統形(xing)式的脈(mo)(mo)象指標為(wei);

1、微脈(mo)(mo)屬于具有復合因素(su)的脈(mo)(mo)象。

2、微脈是(shi)細(xi)無力,若(ruo)有若(ruo)無,模糊不清的幾種(zhong)因素綜合(he)而成。

3、有人將蜘絲與羹上肥結合起來形容微(wei)脈,雖然(ran)有與細、散等交叉重復的(de)問題,但亦可供一定參考。

4、微脈可(ke)以與有關脈象(xiang)結合而構(gou)成兼(jian)脈。

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