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中醫脈象之芤脈

佚名 2023-11-13 12:57:50

芤脈(mo)是(shi)(shi)屬于具有復合因素的(de)脈(mo)象,它(ta)是(shi)(shi)浮、大、中(zhong)空、無(wu)力的(de)幾種條(tiao)件(jian)的(de)綜合體(ti),芤脈(mo)與(yu)虛脈(mo)不(bu)(bu)同的(de)是(shi)(shi)它(ta)的(de)無(wu)力更(geng)多表現在“中(zhong)”,而兩邊(實際是(shi)(shi)反應(ying)“外”)卻相(xiang)對的(de)有一定力度(du),不(bu)(bu)過較(jiao)正常脈(mo)的(de)力度(du)仍(reng)是(shi)(shi)不(bu)(bu)足(zu)的(de)亡(wang)與(yu)虛脈(mo)的(de)虛軟無(wu)力,豁然(ran)浮大表里皆不(bu)(bu)足(zu)不(bu)(bu)同。

這是(shi)(shi)由于芤脈(mo)是(shi)(shi)在失血的(de)(de)(de)情況下出(chu)現血脈(mo)的(de)(de)(de)內容(血液(ye)減少)而(er)在指壓切(qie)脈(mo)的(de)(de)(de)情況下,脈(mo)管受壓后因(yin)為(wei)物理和力學上的(de)(de)(de)原(yuan)因(yin),就形(xing)成兩側相對明顯(xian)而(er)中(zhong)間(jian)空軟的(de)(de)(de)感(gan)覺。既所(suo)謂(wei)“有(you)邊無(wu)中(zhong)”。蔥古作(zuo)蒽(en),一作(zuo)芤,所(suo)以芤就是(shi)(shi)蒽(en),古人(ren)用(yong)蔥管來形(xing)存(cun)脈(mo)管的(de)(de)(de)形(xing)狀(zhuang)和性質,這個(ge)說法一直(zhi)在沿(yan)用(yong)。總之,芤脈(mo)是(shi)(shi)無(wu)力的(de)(de)(de)脈(mo),但它又有(you)表(biao)里(li)不一的(de)(de)(de)特(te)點,里(li)是(shi)(shi)絕對的(de)(de)(de)空軟,表(biao)是(shi)(shi)相對的(de)(de)(de)有(you)力,故爾何(he)來又有(you)中(zhong)空外(wai)(wai)實如(ru)《脈(mo)經》之說,這個(ge)外(wai)(wai)實亦(yi)是(shi)(shi)比較而(er)言,絕到不了實脈(mo)的(de)(de)(de)程度(du),周學海氏有(you)外(wai)(wai)有(you)一層(ceng)硬皮之說,亦(yi)是(shi)(shi)這個(ge)意思。所(suo)謂(wei)實,硬度(du)都還到不了正(zheng)常(chang)脈(mo)的(de)(de)(de)表(biao)面力度(du)。不過(guo)形(xing)容表(biao)里(li)不一說明有(you)中(zhong)空特(te)點的(de)(de)(de)大面無(wu)力的(de)(de)(de)脈(mo)象。

《內經(jing)》沒有(you)(you)芤(kou)(kou)脈(mo)(mo)(mo)(mo),仲景(jing)始有(you)(you)“弦則為減,大則為芤(kou)(kou)”及“脈(mo)(mo)(mo)(mo)浮(fu)(fu)而(er)(er)緊,按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)不芤(kou)(kou)”等,可證(zheng)芤(kou)(kou)脈(mo)(mo)(mo)(mo)已用于臨床辨證(zheng),至于芤(kou)(kou)的(de)(de)脈(mo)(mo)(mo)(mo)形(xing),在(zai)《金匱要略·五臟(zang)風寒積聚病脈(mo)(mo)(mo)(mo)證(zheng)并(bing)治第十一(yi)(yi)》說(shuo):“肺死(si)臟(zang),浮(fu)(fu)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)虛(xu),按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)弱,如蔥葉,下無(wu)(wu)(wu)根者(zhe)死(si)。”這(zhe)里(li)的(de)(de)“弱”是(shi)(shi)無(wu)(wu)(wu)力的(de)(de)意思,不是(shi)(shi)《脈(mo)(mo)(mo)(mo)經(jing)》以(yi)來(lai)(lai)的(de)(de)沉細無(wu)(wu)(wu)力為弱的(de)(de)弱脈(mo)(mo)(mo)(mo)。根據(ju)這(zhe)一(yi)(yi)段的(de)(de)描述很(hen)明顯是(shi)(shi)芤(kou)(kou)脈(mo)(mo)(mo)(mo),但芤(kou)(kou)脈(mo)(mo)(mo)(mo)與無(wu)(wu)(wu)根是(shi)(shi)在(zai)脈(mo)(mo)(mo)(mo)形(xing)脈(mo)(mo)(mo)(mo)勢(shi)上(shang)有(you)(you)區別的(de)(de),一(yi)(yi)般急性失血脈(mo)(mo)(mo)(mo)不一(yi)(yi)定(ding)是(shi)(shi)無(wu)(wu)(wu)根之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)象(xiang),但如果在(zai)芤(kou)(kou)脈(mo)(mo)(mo)(mo)的(de)(de)情況下,再加上(shang)無(wu)(wu)(wu)根當然是(shi)(shi)死(si)證(zheng)了(le)。《脈(mo)(mo)(mo)(mo)經(jing)》對芤(kou)(kou)脈(mo)(mo)(mo)(mo)作(zuo)了(le)標(biao)準的(de)(de)解(jie)(jie)釋:“芤(kou)(kou)脈(mo)(mo)(mo)(mo)脈(mo)(mo)(mo)(mo)浮(fu)(fu)大而(er)(er)軟(ruan),按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)中(zhong)(zhong)央空(kong),兩(liang)(liang)(liang)(liang)邊(bian)實(shi)。”“一(yi)(yi)日(ri)手下無(wu)(wu)(wu),兩(liang)(liang)(liang)(liang)旁有(you)(you)。”兩(liang)(liang)(liang)(liang)說(shuo)的(de)(de)意思是(shi)(shi)一(yi)(yi)樣(yang)的(de)(de),成為芤(kou)(kou)脈(mo)(mo)(mo)(mo)經(jing)典的(de)(de)解(jie)(jie)釋。其(qi)后歷代諸家之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)說(shuo)均從(cong)此出。如《千金翼方》:“按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)無(wu)(wu)(wu),舉之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)來(lai)(lai),兩(liang)(liang)(liang)(liang)傍實(shi)而(er)(er)中(zhong)(zhong)央空(kong)名(ming)(ming)日(ri)芤(kou)(kou)。”宋(song)·曾慥《類(lei)說(shuo)》引《徐氏(shi)脈(mo)(mo)(mo)(mo)訣(jue)》(原書已佚)名(ming)(ming)見(jian)《中(zhong)(zhong)國醫籍考》說(shuo):“按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)即(ji)無(wu)(wu)(wu),舉之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)來(lai)(lai)至,旁實(shi)中(zhong)(zhong)空(kong)者(zhe),曰芤(kou)(kou)。”朱肽《括人書》說(shuo):“浮(fu)(fu)大而(er)(er)軟(ruan),按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)中(zhong)(zhong)央空(kong),兩(liang)(liang)(liang)(liang)邊(bian)實(shi)。”《崔(cui)氏(shi)脈(mo)(mo)(mo)(mo)訣(jue)》說(shuo):“浮(fu)(fu)而(er)(er)無(wu)(wu)(wu)力,是(shi)(shi)名(ming)(ming)芤(kou)(kou)脈(mo)(mo)(mo)(mo)。”芤(kou)(kou)脈(mo)(mo)(mo)(mo)何(he)似,絕類(lei)蔥蔥,指下成窟,有(you)(you)邊(bian)無(wu)(wu)(wu)中(zhong)(zhong)。”李(li)東垣(yuan)的(de)(de)批注(zhu)說(shuo):“芤(kou)(kou)音摳,訣(jue)云按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)即(ji)無(wu)(wu)(wu),舉之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)即(ji)有(you)(you),兩(liang)(liang)(liang)(liang)邊(bian)實(shi),中(zhong)(zhong)央空(kong)者(zhe),名(ming)(ming)日(ri)芤(kou)(kou)。”《診(zhen)(zhen)家樞要》說(shuo):“浮(fu)(fu)大而(er)(er)軟(ruan),尋之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)中(zhong)(zhong)空(kong)旁實(shi),旁有(you)(you)中(zhong)(zhong)無(wu)(wu)(wu),診(zhen)(zhen)在(zai)浮(fu)(fu)舉重按(an)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)間”。

古(gu)人(ren)說(shuo)(shuo)(shuo)的(de)(de)中(zhong)(zhong)(zhong)空(kong)(kong)應該是(shi)(shi)(shi)(shi)一種空(kong)(kong)軟(ruan)(ruan)(ruan)的(de)(de)感覺(jue),滑氏添出旁有(you)中(zhong)(zhong)(zhong)無,就(jiu)是(shi)(shi)(shi)(shi)中(zhong)(zhong)(zhong)間完全沒有(you)了,適成“癡人(ren)說(shuo)(shuo)(shuo)夢(meng)”。在實踐中(zhong)(zhong)(zhong)并(bing)非如(ru)(ru)此(ci),后(hou)人(ren)再執此(ci)以求,于是(shi)(shi)(shi)(shi)芤(kou)脈(mo)(mo)(mo)漸不明(ming)于世。但《診(zhen)家(jia)(jia)樞要》的(de)(de)解釋原則上與(yu)《脈(mo)(mo)(mo)經(jing)》還(huan)是(shi)(shi)(shi)(shi)一致的(de)(de)。《外科精義》說(shuo)(shuo)(shuo):“芤(kou)脈(mo)(mo)(mo)之(zhi)診(zhen),似(si)浮(fu)(fu)而(er)軟(ruan)(ruan)(ruan),按(an)之(zhi)中(zhong)(zhong)(zhong)央(yang)空(kong)(kong)兩(liang)邊(bian)(bian)(bian)實。”《脈(mo)(mo)(mo)訣指(zhi)(zhi)(zhi)掌》說(shuo)(shuo)(shuo):“芤(kou)者(zhe)中(zhong)(zhong)(zhong)空(kong)(kong)傍(bang)實,如(ru)(ru)按(an)慈蔥。”《醫(yi)經(jing)小(xiao)學(xue)》說(shuo)(shuo)(shuo):“芤(kou)脈(mo)(mo)(mo)中(zhong)(zhong)(zhong)空(kong)(kong)兩(liang)噼(pi)居。”《太素脈(mo)(mo)(mo)秘訣》說(shuo)(shuo)(shuo):“中(zhong)(zhong)(zhong)軟(ruan)(ruan)(ruan)傍(bang)實,按(an)無舉有(you)。”雖然語不及(ji)浮(fu)(fu)大(da)(da)(da),但形象的(de)(de)描述(shu)還(huan)是(shi)(shi)(shi)(shi)對的(de)(de)。《瀕湖脈(mo)(mo)(mo)學(xue)》之(zhi)說(shuo)(shuo)(shuo)引《脈(mo)(mo)(mo)經(jing)》并(bing)參以其(qi)他(ta)成說(shuo)(shuo)(shuo),要言不煩,且無所(suo)失(shi)。他(ta)說(shuo)(shuo)(shuo):“芤(kou)脈(mo)(mo)(mo)浮(fu)(fu)大(da)(da)(da)而(er)軟(ruan)(ruan)(ruan),按(an)之(zhi)中(zhong)(zhong)(zhong)央(yang)空(kong)(kong),兩(liang)邊(bian)(bian)(bian)實,中(zhong)(zhong)(zhong)空(kong)(kong)外實,狀類慈蔥。”吳昆《脈(mo)(mo)(mo)語》說(shuo)(shuo)(shuo):“芤(kou),脈(mo)(mo)(mo)來形大(da)(da)(da)如(ru)(ru)蔥,接之(zhi)中(zhong)(zhong)(zhong)央(yang)空(kong)(kong),兩(liang)邊(bian)(bian)(bian)實,日芤(kou)。”《景岳全書》說(shuo)(shuo)(shuo):“浮(fu)(fu)大(da)(da)(da)中(zhong)(zhong)(zhong)空(kong)(kong),按(an)如(ru)(ru)蔥管。”此(ci)后(hou)諸(zhu)家(jia)(jia)如(ru)(ru)《醫(yi)學(xue)真傳》、《脈(mo)(mo)(mo)法統宗》、《三指(zhi)(zhi)(zhi)禪》、《診(zhen)家(jia)(jia)直訣》、《醫(yi)學(xue)探(tan)驪》、《脈(mo)(mo)(mo)如(ru)(ru)》、《醫(yi)述(shu)》等直至《中(zhong)(zhong)(zhong)國醫(yi)學(xue)大(da)(da)(da)辭典》,都主(zhu)此(ci)說(shuo)(shuo)(shuo),《中(zhong)(zhong)(zhong)醫(yi)脈(mo)(mo)(mo)學(xue)研究》亦(yi)說(shuo)(shuo)(shuo):“芤(kou)脈(mo)(mo)(mo)應指(zhi)(zhi)(zhi)還(huan)有(you)力(li)(相對的(de)(de)),所(suo)以古(gu)人(ren)形容它像蔥管亦(yi)就(jiu)是(shi)(shi)(shi)(shi)有(you)邊(bian)(bian)(bian)無中(zhong)(zhong)(zhong)。所(suo)以說(shuo)(shuo)(shuo)中(zhong)(zhong)(zhong)央(yang)空(kong)(kong),兩(liang)邊(bian)(bian)(bian)實的(de)(de)說(shuo)(shuo)(shuo)法是(shi)(shi)(shi)(shi)正(zheng)確的(de)(de)經(jing)典的(de)(de),是(shi)(shi)(shi)(shi)經(jing)過(guo)長時(shi)期歷史考(kao)驗而(er)被承認的(de)(de)。與(yu)此(ci)不同(tong)的(de)(de)是(shi)(shi)(shi)(shi)在明(ming)清之(zhi)際出現了對中(zhong)(zhong)(zhong)空(kong)(kong)的(de)(de)另一種解釋,那便(bian)是(shi)(shi)(shi)(shi)浮(fu)(fu)沉有(you)中(zhong)(zhong)(zhong)取(qu)無。

例如(ru)《通雅(ya)·脈(mo)(mo)考》說(shuo)(shuo)(shuo):“芤如(ru)蔥(cong)(cong)管,浮沉(chen)可(ke)見,中(zhong)候則無(wu)(wu)。”《脈(mo)(mo)訣匯辨》說(shuo)(shuo)(shuo):“芤乃單名,絕(jue)類慈蔥(cong)(cong),浮沉(chen)俱有,中(zhong)候獨空。”后(hou)來黃元御(yu)的《脈(mo)(mo)理(li)求真》更鑿(zao)鑿(zao)以言(yan)之(zhi),他說(shuo)(shuo)(shuo):“芤則如(ru)指(zhi)著(zhu)(zhu)蔥(cong)(cong),浮取(qu)(qu)得上面(mian)之(zhi)蔥(cong)(cong)皮(pi)(pi)卻(que)顯弦大,中(zhong)取(qu)(qu)減小空中(zhong),按(an)之(zhi)叉著(zhu)(zhu)下面(mian)蔥(cong)(cong)皮(pi)(pi)而有根(gen)據:”這看起來像是(shi)(shi)很認(ren)真很實際,但實則穿鑿(zao)附會到(dao)根(gen)點了(le)(le)(le)。第一(yi)按(an)脈(mo)(mo)不(bu)(bu)是(shi)(shi)直接接觸(chu)脈(mo)(mo)管而是(shi)(shi)隔著(zhu)(zhu)皮(pi)(pi)膚和(he)皮(pi)(pi)膚下組織間接觸(chu)及,不(bu)(bu)是(shi)(shi)手(shou)里拿著(zhu)(zhu)根(gen)蔥(cong)(cong),二是(shi)(shi)診脈(mo)(mo)是(shi)(shi)按(an)脈(mo)(mo)的跳動(dong)(dong),如(ru)果脈(mo)(mo)不(bu)(bu)跳動(dong)(dong)什么亦摸不(bu)(bu)到(dao),別說(shuo)(shuo)(shuo)蔥(cong)(cong)管了(le)(le)(le),別說(shuo)(shuo)(shuo)蔥(cong)(cong)管的下面(mian)那一(yi)面(mian)的蔥(cong)(cong)皮(pi)(pi)了(le)(le)(le)。浮沉(chen)有中(zhong)取(qu)(qu)無(wu)(wu)的脈(mo)(mo)在物理(li)上是(shi)(shi)絕(jue)對(dui)不(bu)(bu)可(ke)能(neng)有的。因為(wei)中(zhong)取(qu)(qu)無(wu)(wu)時就(jiu)將脈(mo)(mo)搏壓住了(le)(le)(le),血(xue)液可(ke)能(neng)流動(dong)(dong),但其力(li)已(yi)不(bu)(bu)足以波動(dong)(dong)了(le)(le)(le),所以就(jiu)不(bu)(bu)跳動(dong)(dong)了(le)(le)(le),中(zhong)取(qu)(qu)已(yi)經如(ru)此(ci)再重按(an)沉(chen)取(qu)(qu)它反(fan)而跳動(dong)(dong)起來了(le)(le)(le),豈非咄咄怪(guai)事!日本(ben)人(ren)丹渡元簡說(shuo)(shuo)(shuo)他父親終生沒有見到(dao)過(guo)芤脈(mo)(mo),大概就(jiu)是(shi)(shi)指(zhi)這種所謂(wei)芤脈(mo)(mo),因為(wei)它不(bu)(bu)可(ke)能(neng)存在,所以使人(ren)終生不(bu)(bu)一(yi)遇,提出這種說(shuo)(shuo)(shuo)法的人(ren)亦是(shi)(shi)全(quan)憑想象,而黃元御(yu)更是(shi)(shi)慣于“師(shi)心自用”大言(yan)欺人(ren)的。

脈(mo)(mo)學是一種診(zhen)(zhen)療技術,尤(you)其(qi)是脈(mo)(mo)形要在客觀實踐的基礎(chu)上提出切實的指標,賣(mai)弄聰(cong)明是沒有用(yong)的。其(qi)他如《診(zhen)(zhen)家(jia)正眼》、《四診(zhen)(zhen)抉微》、《醫(yi)宗金鑒》、《洄溪(xi)脈(mo)(mo)學》、《醫(yi)碥》、《醫(yi)醇剩義》等書亦主(zhu)是說,均屬未加思考以訛傳訛。

《脈(mo)(mo)(mo)(mo)訣(jue)》對(dui)芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo)的(de)(de)(de)(de)(de)解釋亦(yi)有(you)(you)(you)(you)(you)(you)(you)(you)錯(cuo)誤(wu),但(dan)(dan)影響不(bu)(bu)太大,面且得(de)到糾正(zheng)。《脈(mo)(mo)(mo)(mo)訣(jue)》說(shuo)(shuo)(shuo):“芤(kou)(kou)(kou)(kou)者陽(yang)也(ye)。指(zhi)(zhi)下尋(xun)之(zhi)(zhi),兩(liang)(liang)頭即(ji)有(you)(you)(you)(you)(you)(you)(you)(you),中(zhong)(zhong)(zhong)(zhong)間(jian)(jian)(jian)(jian)(jian)全無(wu)(wu)(wu),日(ri)芤(kou)(kou)(kou)(kou)。”將兩(liang)(liang)邊改成兩(liang)(liang)頭當(dang)(dang)然是不(bu)(bu)對(dui)的(de)(de)(de)(de)(de),《察(cha)病指(zhi)(zhi)南》引(yin)(yin)用了(le)《脈(mo)(mo)(mo)(mo)訣(jue)》說(shuo)(shuo)(shuo),但(dan)(dan)又引(yin)(yin)《脈(mo)(mo)(mo)(mo)經(jing)(jing)(jing)》等說(shuo)(shuo)(shuo)以(yi)致內(nei)容混淆(xiao)矛盾(dun)。說(shuo)(shuo)(shuo):“指(zhi)(zhi)下哥之(zhi)(zhi),兩(liang)(liang)頭即(ji)有(you)(you)(you)(you)(you)(you)(you)(you),中(zhong)(zhong)(zhong)(zhong)間(jian)(jian)(jian)(jian)(jian)全無(wu)(wu)(wu),其(qi)(qi)脈(mo)(mo)(mo)(mo)浮(fu)大而軟,按(an)之(zhi)(zhi)中(zhong)(zhong)(zhong)(zhong)央(yang)空(kong)(kong),兩(liang)(liang)邊實,喻(yu)似指(zhi)(zhi)按(an)芤(kou)(kou)(kou)(kou)草葉,芤(kou)(kou)(kou)(kou)葉即(ji)蔥(cong)類,中(zhong)(zhong)(zhong)(zhong)心空(kong)(kong)虛(xu)(xu),故名(ming)日(ri)芤(kou)(kou)(kou)(kou)也(ye)。”《脈(mo)(mo)(mo)(mo)訣(jue)刊誤(wu)》對(dui)《脈(mo)(mo)(mo)(mo)訣(jue)》作(zuo)了(le)分(fen)(fen)析批判(pan)說(shuo)(shuo)(shuo);“《脈(mo)(mo)(mo)(mo)經(jing)(jing)(jing)》日(ri)芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo),其(qi)(qi)象(xiang)(xiang)兩(liang)(liang)邊似有(you)(you)(you)(you)(you)(you)(you)(you),中(zhong)(zhong)(zhong)(zhong)間(jian)(jian)(jian)(jian)(jian)全無(wu)(wu)(wu),今《脈(mo)(mo)(mo)(mo)訣(jue)》乃日(ri),兩(liang)(liang)頭則(ze)有(you)(you)(you)(you)(you)(you)(you)(you),中(zhong)(zhong)(zhong)(zhong)間(jian)(jian)(jian)(jian)(jian)全無(wu)(wu)(wu),則(ze)誤(wu)矣,夫尺(chi)脈(mo)(mo)(mo)(mo)上不(bu)(bu)至(zhi)(zhi)關為(wei)陰絕,寸口不(bu)(bu)至(zhi)(zhi)關為(wei)陽(yang)絕,若兩(liang)(liang)頭似有(you)(you)(you)(you)(you)(you)(you)(you),中(zhong)(zhong)(zhong)(zhong)間(jian)(jian)(jian)(jian)(jian)全無(wu)(wu)(wu)則(ze)是陰陽(yang)絕脈(mo)(mo)(mo)(mo)也(ye),安得(de)為(wei)芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo)乎?!”“芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo)先舉指(zhi)(zhi)時浮(fu)大而軟,因按(an)而中(zhong)(zhong)(zhong)(zhong)空(kong)(kong)。今《脈(mo)(mo)(mo)(mo)訣(jue)》言指(zhi)(zhi)下尋(xun)之(zhi)(zhi)非也(ye)。仲(zhong)景(jing)日(ri):‘脈(mo)(mo)(mo)(mo)浮(fu)而緊(jin),按(an)之(zhi)(zhi)不(bu)(bu)芤(kou)(kou)(kou)(kou),此人(ren)本不(bu)(bu)虛(xu)(xu)。’是指(zhi)(zhi)于(yu)(yu)按(an)上以(yi)見芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo),尋(xun)者在浮(fu)舉沉按(an)之(zhi)(zhi)間(jian)(jian)(jian)(jian)(jian)耳。”李時珍亦(yi)說(shuo)(shuo)(shuo):“《脈(mo)(mo)(mo)(mo)訣(jue)》言,兩(liang)(liang)頭有(you)(you)(you)(you)(you)(you)(you)(you),中(zhong)(zhong)(zhong)(zhong)間(jian)(jian)(jian)(jian)(jian)無(wu)(wu)(wu)是脈(mo)(mo)(mo)(mo)斷截矣。”王士亨亦(yi)有(you)(you)(you)(you)(you)(you)(you)(you)中(zhong)(zhong)(zhong)(zhong)斷之(zhi)(zhi)說(shuo)(shuo)(shuo)當(dang)(dang)然亦(yi)是錯(cuo)的(de)(de)(de)(de)(de)。《壽(shou)世保元(yuan)》、《沈氏(shi)尊(zun)生書》只提(ti)出浮(fu)而無(wu)(wu)(wu)力(li)(li),而不(bu)(bu)及中(zhong)(zhong)(zhong)(zhong)空(kong)(kong)邊實等根(gen)本不(bu)(bu)能說(shuo)(shuo)(shuo)是芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo)。《診宗三昧》提(ti)出有(you)(you)(you)(you)(you)(you)(you)(you)弦(xian)的(de)(de)(de)(de)(de)條件(jian)(jian),將相(xiang)對(dui)力(li)(li)度說(shuo)(shuo)(shuo)得(de)太過,芤(kou)(kou)(kou)(kou)是無(wu)(wu)(wu)力(li)(li)的(de)(de)(de)(de)(de)脈(mo)(mo)(mo)(mo),雖(sui)外表相(xiang)對(dui)有(you)(you)(you)(you)(you)(you)(you)(you)力(li)(li)亦(yi)不(bu)(bu)如(ru)正(zheng)常脈(mo)(mo)(mo)(mo)的(de)(de)(de)(de)(de)力(li)(li)度,更不(bu)(bu)能出現(xian)弦(xian)象(xiang)(xiang),如(ru)有(you)(you)(you)(you)(you)(you)(you)(you)弦(xian)象(xiang)(xiang)則(ze)是革脈(mo)(mo)(mo)(mo),而非單(dan)純芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo),這在仲(zhong)景(jing)早(zao)有(you)(you)(you)(you)(you)(you)(you)(you)明訓(xun)歷(li)代(dai)亦(yi)無(wu)(wu)(wu)異議(yi),故弦(xian)的(de)(de)(de)(de)(de)條件(jian)(jian)是混淆(xiao)了(le)芤(kou)(kou)(kou)(kou)革的(de)(de)(de)(de)(de)界(jie)限,無(wu)(wu)(wu)疑是錯(cuo)誤(wu)的(de)(de)(de)(de)(de)。芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo)自《脈(mo)(mo)(mo)(mo)經(jing)(jing)(jing)》提(ti)出脈(mo)(mo)(mo)(mo)形(xing)(xing)指(zhi)(zhi)標以(yi)來,除《脈(mo)(mo)(mo)(mo)訣(jue)》有(you)(you)(you)(you)(you)(you)(you)(you)明顯錯(cuo)誤(wu)后被批判(pan)澄清以(yi)外,歷(li)代(dai)并無(wu)(wu)(wu)異議(yi)。但(dan)(dan)自明清之(zhi)(zhi)際起(qi),部分(fen)(fen)醫家(jia)有(you)(you)(you)(you)(you)(you)(you)(you)“浮(fu)沉有(you)(you)(you)(you)(you)(you)(you)(you)中(zhong)(zhong)(zhong)(zhong)取無(wu)(wu)(wu)”之(zhi)(zhi)誤(wu)說(shuo)(shuo)(shuo),形(xing)(xing)成一(yi)定的(de)(de)(de)(de)(de)干擾,這是芤(kou)(kou)(kou)(kou)脈(mo)(mo)(mo)(mo)形(xing)(xing)中(zhong)(zhong)(zhong)(zhong)的(de)(de)(de)(de)(de)一(yi)個大問題,應當(dang)(dang)辨明,其(qi)(qi)他小的(de)(de)(de)(de)(de)誤(wu)說(shuo)(shuo)(shuo),如(ru)兼弦(xian)等影響不(bu)(bu)大亦(yi)易于(yu)(yu)識別。

根據歷(li)史文獻及對(dui)其分(fen)析考證,結合(he)臨床實踐、實驗等經驗體會(hui),擬(ni)訂芤脈(mo)的(de)傳(chuan)統形式的(de)脈(mo)象(xiang)指標為:

1、芤脈是屬(shu)于具有復合(he)因素的(de)脈象。

2、芤脈綜合(he)了(le)浮、大、軟、中空(kong)邊有的幾(ji)種條(tiao)件(jian)形成(cheng)的。

3、自(zi)仲景、叔(shu)和以來常以蔥管形容芤脈(mo),這對芤脈(mo)的說明和理解有較大意(yi)義,是(shi)古人客觀化(hua)說明的好的例子之一。

4、芤脈(mo)(mo)可(ke)(ke)以與(yu)其(qi)他脈(mo)(mo)象結合而構成另外一種(zhong)脈(mo)(mo)象如芤弦相合為革脈(mo)(mo),亦可(ke)(ke)以與(yu)確(que)‘關脈(mo)(mo)象構成兼(jian)脈(mo)(mo)如芤數,芤緩等(deng)。

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